Provider Demographics
NPI:1730422700
Name:DEVINE, CHRISTIAN
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:DEVINE
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:PO BOX 61067
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98141-6067
Mailing Address - Country:US
Mailing Address - Phone:206-771-5721
Mailing Address - Fax:206-467-6337
Practice Address - Street 1:104 PIKE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2010
Practice Address - Country:US
Practice Address - Phone:206-771-5721
Practice Address - Fax:206-467-6337
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60332419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor