Provider Demographics
NPI:1710042510
Name:DREESSEN, JERRALD B (DC CCSP)
Entity Type:Individual
Prefix:
First Name:JERRALD
Middle Name:B
Last Name:DREESSEN
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 220TH ST SW
Mailing Address - Street 2:STE 100
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043
Mailing Address - Country:US
Mailing Address - Phone:425-670-2600
Mailing Address - Fax:425-778-7073
Practice Address - Street 1:6603 220TH ST SW
Practice Address - Street 2:STE 100
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043
Practice Address - Country:US
Practice Address - Phone:425-670-2600
Practice Address - Fax:425-778-7073
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T03102Medicare UPIN
WAAB15227Medicare ID - Type Unspecified