Provider Demographics
NPI:1609949882
Name:ELLISON, KATHERINE DORA (DC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DORA
Last Name:ELLISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 EASTLAKE AVE E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3345
Mailing Address - Country:US
Mailing Address - Phone:206-325-9297
Mailing Address - Fax:206-325-9292
Practice Address - Street 1:2324 EASTLAKE AVE E
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3345
Practice Address - Country:US
Practice Address - Phone:206-325-9297
Practice Address - Fax:206-325-9292
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0143936OtherSTATE INDUSTRIAL ACCIDENT
WAEL7813OtherREGENCE BS
WAEL7813OtherREGENCE BS
WAU74614Medicare UPIN