Provider Demographics
NPI:1417098005
Name:WOODWAY CHIROPRACTIC AND MASSAGE, P.S.
Entity Type:Organization
Organization Name:WOODWAY CHIROPRACTIC AND MASSAGE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FREDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-771-2225
Mailing Address - Street 1:20015 HIGHWAY 99 STE A
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6073
Mailing Address - Country:US
Mailing Address - Phone:425-771-2225
Mailing Address - Fax:425-670-8121
Practice Address - Street 1:20015 HIGHWAY 99 STE A
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6073
Practice Address - Country:US
Practice Address - Phone:425-771-2225
Practice Address - Fax:425-670-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB20580Medicare ID - Type Unspecified
WAU446921Medicare UPIN