Provider Demographics
NPI:1073571501
Name:WESTENHAVER, TY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:CHARLES
Last Name:WESTENHAVER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 196TH ST SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5078
Mailing Address - Country:US
Mailing Address - Phone:425-775-6986
Mailing Address - Fax:425-774-3651
Practice Address - Street 1:7127 196TH ST SW
Practice Address - Street 2:SUITE 101
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5078
Practice Address - Country:US
Practice Address - Phone:425-775-6986
Practice Address - Fax:425-774-3651
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R75544OtherREGENCE
AB04137OtherMEDICARE GROUP
AB04139Medicare ID - Type Unspecified
AB04137OtherMEDICARE GROUP