Provider Demographics
NPI:1962564294
Name:SUNSET BOULEVARD CHIROPRACTIC, P.S.
Entity type:Organization
Organization Name:SUNSET BOULEVARD CHIROPRACTIC, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-299-6900
Mailing Address - Street 1:725 N STANLEY ST
Mailing Address - Street 2:STE. C
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8940
Mailing Address - Country:US
Mailing Address - Phone:509-299-6900
Mailing Address - Fax:509-299-6900
Practice Address - Street 1:725 N STANLEY ST
Practice Address - Street 2:STE. C
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8940
Practice Address - Country:US
Practice Address - Phone:509-299-6900
Practice Address - Fax:509-299-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty