Provider Demographics
NPI:1316134299
Name:REDMOND RIDGE CHIROPRACTIC, P.S.
Entity type:Organization
Organization Name:REDMOND RIDGE CHIROPRACTIC, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAIS
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:FADDAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-868-0120
Mailing Address - Street 1:23525 NE NOVELTY HILL RD # A-109
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-1995
Mailing Address - Country:US
Mailing Address - Phone:425-868-0120
Mailing Address - Fax:425-868-3920
Practice Address - Street 1:23525 NE NOVELTY HILL RD # A-109
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-1995
Practice Address - Country:US
Practice Address - Phone:425-868-0120
Practice Address - Fax:425-868-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty