Provider Demographics
NPI:1417312042
Name:DR. JUSTIN PAQUETTE, DC
Entity Type:Organization
Organization Name:DR. JUSTIN PAQUETTE, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-687-0867
Mailing Address - Street 1:190 HARBOR SQ LOOP NE
Mailing Address - Street 2:C328
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2453
Mailing Address - Country:US
Mailing Address - Phone:818-687-0867
Mailing Address - Fax:
Practice Address - Street 1:910 LENORA ST
Practice Address - Street 2:#160
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2754
Practice Address - Country:US
Practice Address - Phone:206-397-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60608428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty