Provider Demographics
NPI:1336642420
Name:OTTO FAMILY
Entity Type:Organization
Organization Name:OTTO FAMILY
Other - Org Name:LIFE & HEALTH CHIROPRACTIC CENTRE'
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-313-9247
Mailing Address - Street 1:720 S 348TH ST STE A-1B
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7000
Mailing Address - Country:US
Mailing Address - Phone:253-944-7620
Mailing Address - Fax:253-944-7621
Practice Address - Street 1:720 S 348TH ST STE A-1B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-944-7620
Practice Address - Fax:253-944-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty