Provider Demographics
NPI:1699904177
Name:IDEAL HEALTH OF WASHINGTON, INC.
Entity type:Organization
Organization Name:IDEAL HEALTH OF WASHINGTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:253-531-5242
Mailing Address - Street 1:13412 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4866
Mailing Address - Country:US
Mailing Address - Phone:253-531-5242
Mailing Address - Fax:253-537-7293
Practice Address - Street 1:13412 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4866
Practice Address - Country:US
Practice Address - Phone:253-531-5242
Practice Address - Fax:253-537-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty