Provider Demographics
NPI:1891838181
Name:RANDI REBNE DC PS
Entity type:Organization
Organization Name:RANDI REBNE DC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:REBNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-323-6353
Mailing Address - Street 1:2800 E MADISON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4865
Mailing Address - Country:US
Mailing Address - Phone:206-323-6353
Mailing Address - Fax:
Practice Address - Street 1:2800 E MADISON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4865
Practice Address - Country:US
Practice Address - Phone:206-323-6353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty