1497933600 NPI number — ODEGARD CHIROPRACTIC CLINIC

Table of content: (NPI 1497933600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497933600 NPI number — ODEGARD CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODEGARD CHIROPRACTIC CLINIC
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:
1497933600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 STATE ST.
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-827-4646
Provider Business Mailing Address Fax Number:
425-827-1941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-827-4646
Provider Business Practice Location Address Fax Number:
425-827-1941
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ODEGARD
Authorized Official First Name:
CARSON
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER DOCTOR
Authorized Official Telephone Number:
425-827-4646

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  1558 , 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)





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