Provider Demographics
NPI:1568863330
Name:MG CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MG CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENSLADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-387-7215
Mailing Address - Street 1:928 NW LEARY WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107
Mailing Address - Country:US
Mailing Address - Phone:425-387-7215
Mailing Address - Fax:
Practice Address - Street 1:928 NW LEARY WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:425-387-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60431420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty