1154552792 NPI number — ABSOLUTE CHIROPRACTIC AND WELLNESS CENTER, INC

Table of content: (NPI 1154552792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154552792 NPI number — ABSOLUTE CHIROPRACTIC AND WELLNESS CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE CHIROPRACTIC AND WELLNESS CENTER, INC
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:
1154552792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
557 ROY ST
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-4219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-285-1068
Provider Business Mailing Address Fax Number:
206-285-0821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
557 ROY ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-285-1068
Provider Business Practice Location Address Fax Number:
206-285-0821
Provider Enumeration Date:
07/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SMALLWOOD
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-940-5341

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  CH 00034868 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133NN1002X , with the licence number: 000436 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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