Provider Demographics
NPI:1063584621
Name:BELLEVUE WAY CHIROPRACTIC, P.S.
Entity type:Organization
Organization Name:BELLEVUE WAY CHIROPRACTIC, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-454-2311
Mailing Address - Street 1:410 BELLEVUE WAY SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6672
Mailing Address - Country:US
Mailing Address - Phone:425-454-2311
Mailing Address - Fax:
Practice Address - Street 1:410 BELLEVUE WAY SE
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6672
Practice Address - Country:US
Practice Address - Phone:425-454-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002794111N00000X
WACH00002795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherFEDERAL TAX ID