Provider Demographics
NPI:1295855294
Name:CHIROPRACTIC OF BURIEN, PS
Entity Type:Organization
Organization Name:CHIROPRACTIC OF BURIEN, PS
Other - Org Name:BURIEN MASSAGE THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VISCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP, DC
Authorized Official - Phone:206-244-8805
Mailing Address - Street 1:15217 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1009
Mailing Address - Country:US
Mailing Address - Phone:206-244-8806
Mailing Address - Fax:
Practice Address - Street 1:15217 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1009
Practice Address - Country:US
Practice Address - Phone:206-244-8806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH2778111N00000X
WAMA5058225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty