Provider Demographics
NPI:1376813154
Name:SAMELAK, SHARONROSE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARONROSE
Middle Name:ANN
Last Name:SAMELAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 N 35TH ST STE 108F
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8889
Mailing Address - Country:US
Mailing Address - Phone:206-565-9691
Mailing Address - Fax:
Practice Address - Street 1:753 N 35TH ST STE 108F
Practice Address - Street 2:SUITE G
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8889
Practice Address - Country:US
Practice Address - Phone:206-565-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9175836OtherAETNA
MI0H27454OtherBCBS OF MICHIGAN
MI0N45101006Medicare UPIN