Provider Demographics
NPI:1114165891
Name:BIRNBACH, JEANNETTE BLAIR (DC, MS, CN, CCN)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:BLAIR
Last Name:BIRNBACH
Suffix:
Gender:F
Credentials:DC, MS, CN, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15230 NE 24TH ST
Mailing Address - Street 2:SUITE E (2ND FLOOR)
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5540
Mailing Address - Country:US
Mailing Address - Phone:425-727-2878
Mailing Address - Fax:
Practice Address - Street 1:15230 NE 24TH ST
Practice Address - Street 2:SUITE E (2ND FLOOR)
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5540
Practice Address - Country:US
Practice Address - Phone:425-727-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034687111N00000X
WANU00001972133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133N00000XDietary & Nutritional Service ProvidersNutritionist