1841468899 NPI number — WELLNESS FOR LIFE CHIROPRACTIC, INC.

Table of content: (NPI 1841468899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841468899 NPI number — WELLNESS FOR LIFE CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESS FOR LIFE CHIROPRACTIC, 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:
BALLARD BACK PAIN RELIEF CLINIC, LLC
Provider Other Organization Name Type Code:
5
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:
1841468899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6204 8TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98107-2270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-784-3494
Provider Business Mailing Address Fax Number:
206-789-2088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6204 8TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-3494
Provider Business Practice Location Address Fax Number:
206-789-2088
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOATS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
HUNTER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-784-3494

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034506 , 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: 713398 . This is a "ACN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0227750 . This is a "DEPARTMENT OF LABOR & IND" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0309134 . This is a "DEPARTMENT OF LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 681270 . This is a "ACN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com