Provider Demographics
NPI:1275987893
Name:PACIFIC COAST WELLNESS PLLC
Entity Type:Organization
Organization Name:PACIFIC COAST WELLNESS PLLC
Other - Org Name:VITALITY SPECIFIC CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-381-4460
Mailing Address - Street 1:19122 BEARDSLEE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-0200
Mailing Address - Country:US
Mailing Address - Phone:425-381-4460
Mailing Address - Fax:425-381-4464
Practice Address - Street 1:19122 BEARDSLEE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-0200
Practice Address - Country:US
Practice Address - Phone:206-297-2792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60494260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty