Provider Demographics
NPI:1609116615
Name:GREENWADE, ZACH R (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACH
Middle Name:R
Last Name:GREENWADE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2104
Mailing Address - Country:US
Mailing Address - Phone:425-429-4178
Mailing Address - Fax:206-932-8686
Practice Address - Street 1:2920 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2104
Practice Address - Country:US
Practice Address - Phone:425-429-4178
Practice Address - Fax:206-932-8686
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60331091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA46-2144951OtherPREMERA
WA46-2144951OtherFIRST CHOICE
WA46-2144951OtherAETNA
WA46-2144951OtherCIGNA
WA46-2144951OtherLABORS & INDUSTRIES
WA46-2144951OtherREGENTS
WA46-2144951OtherPREMERA BLUE CROSS