Provider Demographics
NPI:1386006799
Name:FUNCTIONAL HEALTH CENTER OF SEATTLE LLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEALTH CENTER OF SEATTLE LLC
Other - Org Name:FUNCTIONAL HEALTH CENTER OF BELLEVUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIELS
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-556-1212
Mailing Address - Street 1:14450 NE 29TH PL
Mailing Address - Street 2:UNIT 116
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-8616
Mailing Address - Country:US
Mailing Address - Phone:425-556-1212
Mailing Address - Fax:425-556-1238
Practice Address - Street 1:14450 NE 29TH PL
Practice Address - Street 2:UNIT 116
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-8616
Practice Address - Country:US
Practice Address - Phone:425-556-1212
Practice Address - Fax:425-556-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60602274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty