Provider Demographics
NPI:1568872034
Name:WELLSPRING FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:WELLSPRING FAMILY CHIROPRACTIC PLLC
Other - Org Name:YIN AND YANG CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:N
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-819-3152
Mailing Address - Street 1:8811 S TACOMA WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4595
Mailing Address - Country:US
Mailing Address - Phone:253-581-8444
Mailing Address - Fax:
Practice Address - Street 1:8811 S TACOMA WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4595
Practice Address - Country:US
Practice Address - Phone:253-581-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60286320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty