Provider Demographics
NPI:1114199676
Name:SCHALLMANN, JUSTIN CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CHARLES
Last Name:SCHALLMANN
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 1:2761 152ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5555
Mailing Address - Country:US
Mailing Address - Phone:425-437-9974
Mailing Address - Fax:425-437-9964
Practice Address - Street 1:2761 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5555
Practice Address - Country:US
Practice Address - Phone:425-437-9974
Practice Address - Fax:425-437-9964
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60002301111N00000X
NVB01193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor