Provider Demographics
NPI:1568797371
Name:CONGDON, IAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:R
Last Name:CONGDON
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 1:10212 5TH AVE NE STE 120
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7471
Mailing Address - Country:US
Mailing Address - Phone:206-641-7707
Mailing Address - Fax:206-641-7709
Practice Address - Street 1:10212 5TH AVE NE STE 120
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7471
Practice Address - Country:US
Practice Address - Phone:206-641-7707
Practice Address - Fax:206-641-7709
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60115439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH60115439OtherSTATE DEPARTMENT OF LICENSING