Provider Demographics
NPI:1477693000
Name:ADDAMS, JIRAYA MICHIO (LMP)
Entity Type:Individual
Prefix:MR
First Name:JIRAYA
Middle Name:MICHIO
Last Name:ADDAMS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:MICHAEL
Other - Last Name:ALLDREDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:SUITE 1700 (LONG LIFE ACU)
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:206-323-6824
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 1700 (LONG LIFE ACU)
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:206-323-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist