Provider Demographics
NPI:1518037571
Name:WARDAK, ISLAMUDDIN (DC)
Entity Type:Individual
Prefix:
First Name:ISLAMUDDIN
Middle Name:
Last Name:WARDAK
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 1:1204 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4419
Mailing Address - Country:US
Mailing Address - Phone:206-329-3040
Mailing Address - Fax:206-329-3041
Practice Address - Street 1:1204 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4419
Practice Address - Country:US
Practice Address - Phone:206-329-3040
Practice Address - Fax:206-329-3041
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor