Provider Demographics
NPI:1033406087
Name:NON SURGICAL SPINE CARE CENTER 1 PLLC
Entity Type:Organization
Organization Name:NON SURGICAL SPINE CARE CENTER 1 PLLC
Other - Org Name:NON SURGICAL SPINE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:426-643-4454
Mailing Address - Street 1:1240 116TH AVE NE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3815
Mailing Address - Country:US
Mailing Address - Phone:425-455-3472
Mailing Address - Fax:
Practice Address - Street 1:1240 116TH AVE NE
Practice Address - Street 2:SUITE #101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3815
Practice Address - Country:US
Practice Address - Phone:425-455-3472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty