Provider Demographics
NPI:1043655467
Name:GENESIS CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:GENESIS CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASUD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-725-2225
Mailing Address - Street 1:3756 RAINIER AVE S STE D
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6989
Mailing Address - Country:US
Mailing Address - Phone:206-725-2225
Mailing Address - Fax:206-725-0185
Practice Address - Street 1:3756 RAINIER AVE S STE D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6989
Practice Address - Country:US
Practice Address - Phone:206-725-2225
Practice Address - Fax:206-725-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty