Provider Demographics
NPI:1033482559
Name:FAST BRAIN
Entity Type:Organization
Organization Name:FAST BRAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:425-518-9077
Mailing Address - Street 1:1607 24TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7367
Mailing Address - Country:US
Mailing Address - Phone:425-518-9077
Mailing Address - Fax:
Practice Address - Street 1:5712 E LAKE SAMMAMISH PKWY SE STE 106
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8943
Practice Address - Country:US
Practice Address - Phone:425-518-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IHCMEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003657111NN0400X
NT60096656175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU75052Medicare UPIN
WA8858878Medicare PIN