Provider Demographics
NPI:1124212618
Name:MICHAEL F. FAILLA, INC., P.S.
Entity Type:Organization
Organization Name:MICHAEL F. FAILLA, INC., P.S.
Other - Org Name:EVERGREEN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:FAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-323-1666
Mailing Address - Street 1:1666 E OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5627
Mailing Address - Country:US
Mailing Address - Phone:206-323-1666
Mailing Address - Fax:206-323-6639
Practice Address - Street 1:1666 E OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5627
Practice Address - Country:US
Practice Address - Phone:206-323-1666
Practice Address - Fax:206-323-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH01739261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center