Provider Demographics
NPI:1043396740
Name:FAMILY CHIROPRACTIC HEALTH CLINIC, INC. P.S.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC HEALTH CLINIC, INC. P.S.
Other - Org Name:FCHC INC P S
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-763-0600
Mailing Address - Street 1:4346 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1446
Mailing Address - Country:US
Mailing Address - Phone:206-763-0600
Mailing Address - Fax:206-763-0601
Practice Address - Street 1:4346 15TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1446
Practice Address - Country:US
Practice Address - Phone:206-763-0600
Practice Address - Fax:206-763-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012664Medicaid
WA33520OtherL&I
WAU20851Medicare UPIN