Provider Demographics
NPI:1033257902
Name:GUAN, CONNIE S (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:GUAN
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WELLS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-2715
Mailing Address - Country:US
Mailing Address - Phone:425-687-2707
Mailing Address - Fax:425-687-2707
Practice Address - Street 1:309 WELLS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2715
Practice Address - Country:US
Practice Address - Phone:425-687-2707
Practice Address - Fax:425-687-2707
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU76809Medicare UPIN