Provider Demographics
NPI:1033141338
Name:CHAN, STEPHEN C (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:CHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 116TH AVE NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3034
Mailing Address - Country:US
Mailing Address - Phone:425-467-5955
Mailing Address - Fax:425-467-5839
Practice Address - Street 1:1605 116TH AVE NE
Practice Address - Street 2:SUITE 106
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3034
Practice Address - Country:US
Practice Address - Phone:425-467-5955
Practice Address - Fax:425-467-5839
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8857635Medicare ID - Type Unspecified
U97943Medicare UPIN