Provider Demographics
NPI:1710240841
Name:SEATTLE PAIN RELIEF PLLC
Entity Type:Organization
Organization Name:SEATTLE PAIN RELIEF PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRDSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-354-8311
Mailing Address - Street 1:35002 PACIFIC HWY S
Mailing Address - Street 2:STE A105
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8365
Mailing Address - Country:US
Mailing Address - Phone:425-354-8311
Mailing Address - Fax:
Practice Address - Street 1:35002 PACIFIC HWY S
Practice Address - Street 2:STE A105
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8365
Practice Address - Country:US
Practice Address - Phone:425-354-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
WAMD00016124207Q00000X
WAOA60245584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6705660001Medicare NSC