Provider Demographics
NPI:1215114525
Name:LAKE UNION WELLNESS, PS
Entity type:Organization
Organization Name:LAKE UNION WELLNESS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VEVODA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-749-5253
Mailing Address - Street 1:235 WESTLAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5217
Mailing Address - Country:US
Mailing Address - Phone:206-749-5253
Mailing Address - Fax:206-749-4049
Practice Address - Street 1:235 WESTLAKE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5217
Practice Address - Country:US
Practice Address - Phone:206-749-5253
Practice Address - Fax:206-749-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty