Provider Demographics
NPI:1912107624
Name:VANQUAETHEM CHIROPRACTIC AT MADISON PARK, INC.
Entity type:Organization
Organization Name:VANQUAETHEM CHIROPRACTIC AT MADISON PARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANQUAETHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-726-9595
Mailing Address - Street 1:4105 E MADISON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3291
Mailing Address - Country:US
Mailing Address - Phone:206-726-9595
Mailing Address - Fax:206-320-1468
Practice Address - Street 1:4105 E MADISON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3291
Practice Address - Country:US
Practice Address - Phone:206-726-9595
Practice Address - Fax:206-320-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty