Provider Demographics
NPI:1568906071
Name:ZEPEDA ENTERPRISES, LLC
Entity Type:Organization
Organization Name:ZEPEDA ENTERPRISES, LLC
Other - Org Name:CLEAR CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-653-6350
Mailing Address - Street 1:16700 NE 79TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4465
Mailing Address - Country:US
Mailing Address - Phone:425-861-3832
Mailing Address - Fax:
Practice Address - Street 1:16700 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4465
Practice Address - Country:US
Practice Address - Phone:425-861-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60132467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1144505421Medicare NSC
WA1316278625Medicare NSC
WA1194106765Medicare NSC