Provider Demographics
NPI:1407086648
Name:ALDERWOOD CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ALDERWOOD CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-750-2245
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-0558
Mailing Address - Country:US
Mailing Address - Phone:425-822-4325
Mailing Address - Fax:
Practice Address - Street 1:30 LAKE SHORE PLZ
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6175
Practice Address - Country:US
Practice Address - Phone:425-822-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty