Provider Demographics
NPI:1083925713
Name:WESTWOOD VILLAGE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WESTWOOD VILLAGE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-937-7726
Mailing Address - Street 1:2600 SW BARTON ST
Mailing Address - Street 2:SUITE E-26
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3948
Mailing Address - Country:US
Mailing Address - Phone:206-937-7726
Mailing Address - Fax:
Practice Address - Street 1:2600 SW BARTON ST
Practice Address - Street 2:SUITE E-26
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3948
Practice Address - Country:US
Practice Address - Phone:206-937-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60050318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty