Provider Demographics
NPI:1598281768
Name:WESTSIDE SPINE PS
Entity Type:Organization
Organization Name:WESTSIDE SPINE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-524-3003
Mailing Address - Street 1:6850 35TH AVE NE STE 9
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7344
Mailing Address - Country:US
Mailing Address - Phone:206-524-3003
Mailing Address - Fax:206-527-8998
Practice Address - Street 1:6850 35TH AVE NE STE 9
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7344
Practice Address - Country:US
Practice Address - Phone:206-524-3003
Practice Address - Fax:206-527-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60058655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty