Provider Demographics
NPI:1093984486
Name:OLYMPIC VIEW CHIROPRACTIC, PS
Entity Type:Organization
Organization Name:OLYMPIC VIEW CHIROPRACTIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZOGRAFOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-513-1880
Mailing Address - Street 1:626 128TH ST SW
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6368
Mailing Address - Country:US
Mailing Address - Phone:425-513-1880
Mailing Address - Fax:425-513-6161
Practice Address - Street 1:626 128TH ST SW
Practice Address - Street 2:SUITE 103B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6368
Practice Address - Country:US
Practice Address - Phone:425-513-1880
Practice Address - Fax:425-513-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601822073111N00000X
WAMA00025054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0058732OtherLABOR & INDUSTRIES
WA408006001OtherGROUP HEALTH
WAR76533OtherREGNECE
WA0179721OtherLABOR & INDUSTRIES