Provider Demographics
NPI:1164970778
Name:CENTRAL WELLNESS CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CENTRAL WELLNESS CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-323-0114
Mailing Address - Street 1:1400 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2802
Mailing Address - Country:US
Mailing Address - Phone:206-323-0114
Mailing Address - Fax:844-329-1722
Practice Address - Street 1:1400 20TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2802
Practice Address - Country:US
Practice Address - Phone:206-323-0114
Practice Address - Fax:844-329-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60239267111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8905255Medicare UPIN