Provider Demographics
NPI:1699216150
Name:HYBRID CHIROPRACTIC SPORTS REHAB
Entity Type:Organization
Organization Name:HYBRID CHIROPRACTIC SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SIPRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-971-1942
Mailing Address - Street 1:19031 33RD AVE W
Mailing Address - Street 2:315
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4731
Mailing Address - Country:US
Mailing Address - Phone:425-971-1942
Mailing Address - Fax:
Practice Address - Street 1:19031 33RD AVE W
Practice Address - Street 2:315
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4731
Practice Address - Country:US
Practice Address - Phone:425-971-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60630792111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty