Provider Demographics
NPI:1396154993
Name:SEATAC BURIEN CHIROPRACTIC
Entity type:Organization
Organization Name:SEATAC BURIEN CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VISCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-244-8805
Mailing Address - Street 1:3914 154TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1748
Mailing Address - Country:US
Mailing Address - Phone:206-851-7754
Mailing Address - Fax:
Practice Address - Street 1:15217 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1009
Practice Address - Country:US
Practice Address - Phone:206-244-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018911225700000X
WAMA00012516225700000X
WAMA00012587225700000X
WAMA60299576225700000X
WAMA60518061225700000X
WACH2078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000106466Medicare UPIN