Provider Demographics
NPI:1285751784
Name:VASUDEVA, SUSHIL (DC)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:
Last Name:VASUDEVA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 35TH AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2500
Mailing Address - Country:US
Mailing Address - Phone:206-524-6335
Mailing Address - Fax:206-524-2459
Practice Address - Street 1:9425 35TH AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2500
Practice Address - Country:US
Practice Address - Phone:206-524-6335
Practice Address - Fax:206-524-2459
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111628OtherLABOR & INDUSTRY GROUP NU
WA8869069OtherMEDICARE GROUP NUMBER
WA103256OtherLABOR & INDUSTRY NUMBER
WAVAO633OtherREGENCE RIDER NUMBER
WA111628OtherLABOR & INDUSTRY GROUP NU