Provider Demographics
NPI:1619375482
Name:SOUTHWELL, JOEL WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:WILLIAM
Last Name:SOUTHWELL
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 1:1525 NW MALL ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8947
Mailing Address - Country:US
Mailing Address - Phone:425-800-6881
Mailing Address - Fax:425-392-1039
Practice Address - Street 1:1525 NW MALL ST
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8947
Practice Address - Country:US
Practice Address - Phone:425-800-6881
Practice Address - Fax:425-392-1039
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60505676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor