Provider Demographics
NPI:1073655197
Name:DISCOVERY WELLNESS CENTER
Entity Type:Organization
Organization Name:DISCOVERY WELLNESS CENTER
Other - Org Name:DISCOVERY CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SVETCOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-283-7033
Mailing Address - Street 1:3655 34TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1609
Mailing Address - Country:US
Mailing Address - Phone:206-283-7033
Mailing Address - Fax:
Practice Address - Street 1:3655 34TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1609
Practice Address - Country:US
Practice Address - Phone:206-283-7033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID
WAU96068Medicare UPIN
WA8803809Medicare ID - Type UnspecifiedGROUP