Provider Demographics
NPI:1194997098
Name:TY C WESTENHAVER
Entity type:Organization
Organization Name:TY C WESTENHAVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WESTENHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-775-6986
Mailing Address - Street 1:7127 196TH ST SW SUITE 101
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5078
Mailing Address - Country:US
Mailing Address - Phone:425-775-6986
Mailing Address - Fax:425-774-3651
Practice Address - Street 1:7127 196TH ST SW SUITE 101
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5078
Practice Address - Country:US
Practice Address - Phone:425-775-6986
Practice Address - Fax:425-774-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT03093Medicare UPIN
WAGAB04137Medicare PIN