Provider Demographics
NPI:1609042068
Name:LAKE WASHINGTON CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:LAKE WASHINGTON CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-821-1101
Mailing Address - Street 1:13501 100TH AVE NE STE 50
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5209
Mailing Address - Country:US
Mailing Address - Phone:425-821-1101
Mailing Address - Fax:425-820-4988
Practice Address - Street 1:13501 100TH AVE NE STE 50
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5209
Practice Address - Country:US
Practice Address - Phone:425-821-1101
Practice Address - Fax:425-820-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002675111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000105318Medicare PIN