Provider Demographics
NPI:1699200642
Name:LYNNWOOD FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:LYNNWOOD FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-743-9460
Mailing Address - Street 1:16303 HIGHWAY 99 STE 1B
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1453
Mailing Address - Country:US
Mailing Address - Phone:425-743-9460
Mailing Address - Fax:425-743-9409
Practice Address - Street 1:16303 HIGHWAY 99 STE 1B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1453
Practice Address - Country:US
Practice Address - Phone:425-743-9460
Practice Address - Fax:425-743-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60159932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty