Provider Demographics
NPI:1366631277
Name:SUMMIT CHIROPRACTIC CORP. DBA UNIVERSITY CHIROPRACTIC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC CORP. DBA UNIVERSITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-525-2811
Mailing Address - Street 1:8221 5TH AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4190
Mailing Address - Country:US
Mailing Address - Phone:206-525-2811
Mailing Address - Fax:206-525-2812
Practice Address - Street 1:8221 5TH AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4190
Practice Address - Country:US
Practice Address - Phone:206-525-2811
Practice Address - Fax:206-525-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856211Medicare PIN