Provider Demographics
NPI:1073186011
Name:SUNCREST CHIROPRACTIC AND MASSAGE PLLC
Entity Type:Organization
Organization Name:SUNCREST CHIROPRACTIC AND MASSAGE PLLC
Other - Org Name:SUNCREST CHIROPRACTIC AND MASSAGE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAMANDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-934-1981
Mailing Address - Street 1:5978 HIGHWAY 291 STE 2
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-5105
Mailing Address - Country:US
Mailing Address - Phone:509-934-1981
Mailing Address - Fax:
Practice Address - Street 1:5978 HIGHWAY 291 STE 2
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-5105
Practice Address - Country:US
Practice Address - Phone:509-934-1981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053449025OtherTRIZETTO PROVIDER SOLUTIONS
WA14965494OtherCAQH
WA1053449025OtherTIVITY HEALTH
WA1053449025OtherAMERICAN SPECIALTY HEALTH NETWORK
WA1053449025OtherOPTUM