Provider Demographics
NPI:1316922495
Name:DOWNTOWN SEATTLE CHIROPRACTIC CENTER INC PS
Entity type:Organization
Organization Name:DOWNTOWN SEATTLE CHIROPRACTIC CENTER INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-682-5885
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:STE 1348
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-682-5885
Mailing Address - Fax:206-467-1453
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:STE 1348
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-682-5885
Practice Address - Fax:206-467-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARU5213OtherREGENCE
WA126621OtherL & I
WARU5213OtherREGENCE
AB08261Medicare ID - Type Unspecified