1881883460 NPI number — WELLNESSONE OF EASTGATE, PS

Table of content: (NPI 1881883460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881883460 NPI number — WELLNESSONE OF EASTGATE, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESSONE OF EASTGATE, PS
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:
WELLNESSONE CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1881883460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14700 NE 8TH ST STE 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98007-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-644-8386
Provider Business Mailing Address Fax Number:
425-644-2560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14700 NE 8TH ST STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-289-0092
Provider Business Practice Location Address Fax Number:
425-644-2560
Provider Enumeration Date:
10/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THAIN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
PAULL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-289-0092

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00003604 , 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)