Provider Demographics
NPI:1235474974
Name:OPTIMUM ACUPUNCTURE & CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:OPTIMUM ACUPUNCTURE & CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ALAINE
Authorized Official - Last Name:MESHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MA
Authorized Official - Phone:206-399-9303
Mailing Address - Street 1:506 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6412
Mailing Address - Country:US
Mailing Address - Phone:206-547-3127
Mailing Address - Fax:206-547-8525
Practice Address - Street 1:506 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6412
Practice Address - Country:US
Practice Address - Phone:206-547-3127
Practice Address - Fax:206-547-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0004419084111N00000X
WA0009829807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty