Provider Demographics
NPI:1578296323
Name:COTTRELL CHIROPRACTIC PS
Entity Type:Organization
Organization Name:COTTRELL CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:424-392-9490
Mailing Address - Street 1:140 6TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3341
Mailing Address - Country:US
Mailing Address - Phone:424-392-9490
Mailing Address - Fax:425-427-6401
Practice Address - Street 1:140 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3341
Practice Address - Country:US
Practice Address - Phone:424-392-9490
Practice Address - Fax:425-427-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty