Provider Demographics
NPI:1750653374
Name:WELLNESSONE OF EASTGATE, PS
Entity Type:Organization
Organization Name:WELLNESSONE OF EASTGATE, PS
Other - Org Name:WELLNESSONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAULL
Authorized Official - Last Name:THAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-289-0092
Mailing Address - Street 1:PO BOX 7028
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-1028
Mailing Address - Country:US
Mailing Address - Phone:425-289-0092
Mailing Address - Fax:425-289-0095
Practice Address - Street 1:14700 NE 8TH ST STE 115
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4115
Practice Address - Country:US
Practice Address - Phone:425-289-0092
Practice Address - Fax:425-644-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service