1871518738 NPI number — CHOSEN CHIROPRACTIC LLC

Table of content: (NPI 1871518738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871518738 NPI number — CHOSEN CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOSEN CHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871518738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 120TH AVE NE
Provider Second Line Business Mailing Address:
D104
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-455-5444
Provider Business Mailing Address Fax Number:
425-646-8047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 120TH AVE NE
Provider Second Line Business Practice Location Address:
D104
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-455-5444
Provider Business Practice Location Address Fax Number:
425-646-8047
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHO
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
425-455-5444

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00003585 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121358 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com