Provider Demographics
NPI:1144398785
Name:WELCH, JEREMY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JOHN
Last Name:WELCH
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 1:15015 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5229
Mailing Address - Country:US
Mailing Address - Phone:425-643-4454
Mailing Address - Fax:425-603-0053
Practice Address - Street 1:15015 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5229
Practice Address - Country:US
Practice Address - Phone:425-643-4454
Practice Address - Fax:425-603-0053
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8863145Medicare PIN
WAU93926Medicare UPIN