Provider Demographics
NPI:1033492285
Name:EVIDENCE BASED HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:EVIDENCE BASED HEALTHCARE, PLLC
Other - Org Name:ALIGN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAVREAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-397-3457
Mailing Address - Street 1:910 LENORA ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 LENORA ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2754
Practice Address - Country:US
Practice Address - Phone:206-397-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8870884OtherPTAN