Provider Demographics
NPI:1063776326
Name:SLYCORD, CHRISTOPHER (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SLYCORD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 163RD PL NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3188
Mailing Address - Country:US
Mailing Address - Phone:425-780-6159
Mailing Address - Fax:
Practice Address - Street 1:15015 MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5229
Practice Address - Country:US
Practice Address - Phone:425-780-6159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60294685171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist