Provider Demographics
NPI:1700390267
Name:ADVANCED WELLNESS & REHABILITATION PLLC
Entity Type:Organization
Organization Name:ADVANCED WELLNESS & REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TREBIBSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-698-4411
Mailing Address - Street 1:10513 SILVERDALE WAY NW STE 102
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9499
Mailing Address - Country:US
Mailing Address - Phone:360-698-4411
Mailing Address - Fax:
Practice Address - Street 1:10513 SILVERDALE WAY NW STE 102
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9499
Practice Address - Country:US
Practice Address - Phone:360-698-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADC0005183762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8912636Medicaid