Provider Demographics
NPI:1487865648
Name:CHAD DUVALL PLLC
Entity Type:Organization
Organization Name:CHAD DUVALL PLLC
Other - Org Name:INNERCONNECTION THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-802-3378
Mailing Address - Street 1:2722 EASTLAKE AVE E
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3143
Mailing Address - Country:US
Mailing Address - Phone:425-802-3378
Mailing Address - Fax:206-322-8520
Practice Address - Street 1:2722 EASTLAKE AVE E
Practice Address - Street 2:SUITE 360
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3143
Practice Address - Country:US
Practice Address - Phone:425-802-3378
Practice Address - Fax:206-322-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty