Provider Demographics
NPI:1417099243
Name:SOREM, MONTI D (DC)
Entity Type:Individual
Prefix:DR
First Name:MONTI
Middle Name:D
Last Name:SOREM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 140TH AVE NE
Mailing Address - Street 2:STE D
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2972
Mailing Address - Country:US
Mailing Address - Phone:425-688-0223
Mailing Address - Fax:425-688-0323
Practice Address - Street 1:1050 140TH AVE NE
Practice Address - Street 2:STE D
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2972
Practice Address - Country:US
Practice Address - Phone:425-688-0223
Practice Address - Fax:425-688-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031284Medicaid
WA8855599Medicare ID - Type Unspecified
WA2031284Medicaid