Provider Demographics
NPI:1215195441
Name:SEATTLE LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:SEATTLE LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEADRA
Authorized Official - Middle Name:DAWNYEA
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:206-352-8191
Mailing Address - Street 1:323 QUEEN ANNE AVE N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4543
Mailing Address - Country:US
Mailing Address - Phone:206-352-8191
Mailing Address - Fax:206-352-8190
Practice Address - Street 1:323 QUEEN ANNE AVE N
Practice Address - Street 2:SUITE 1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4543
Practice Address - Country:US
Practice Address - Phone:206-352-8191
Practice Address - Fax:206-352-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty