Provider Demographics
NPI:1588379150
Name:HEWAWASAM, PSACHIEN RAJINTHA
Entity type:Individual
Prefix:
First Name:PSACHIEN
Middle Name:RAJINTHA
Last Name:HEWAWASAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 JUDD ST SE APT 6
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2706
Mailing Address - Country:US
Mailing Address - Phone:360-421-0762
Mailing Address - Fax:
Practice Address - Street 1:100 WALL ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1423
Practice Address - Country:US
Practice Address - Phone:206-448-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61389659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor