Provider Demographics
NPI:1518101724
Name:LYNNWOOD CHIROPRACTIC CLINIC INC PS
Entity Type:Organization
Organization Name:LYNNWOOD CHIROPRACTIC CLINIC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-776-4000
Mailing Address - Street 1:6623 196TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5941
Mailing Address - Country:US
Mailing Address - Phone:425-776-4000
Mailing Address - Fax:425-776-0189
Practice Address - Street 1:6623 196TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5941
Practice Address - Country:US
Practice Address - Phone:425-776-4000
Practice Address - Fax:425-776-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2055903Medicaid
WA2055903Medicaid