Provider Demographics
NPI:1750458790
Name:VANQUAETHEM, STREITER (DC)
Entity Type:Individual
Prefix:DR
First Name:STREITER
Middle Name:
Last Name:VANQUAETHEM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 E MADISON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3291
Mailing Address - Country:US
Mailing Address - Phone:206-726-9595
Mailing Address - Fax:206-320-1468
Practice Address - Street 1:4105 E MADISON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3291
Practice Address - Country:US
Practice Address - Phone:206-726-9595
Practice Address - Fax:206-320-1468
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8850962Medicare ID - Type Unspecified