Provider Demographics
NPI:1770865990
Name:AGAPE CHIROPRACTIC HEALING CENTER, P.S.
Entity Type:Organization
Organization Name:AGAPE CHIROPRACTIC HEALING CENTER, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-888-1670
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-1219
Mailing Address - Country:US
Mailing Address - Phone:425-888-1670
Mailing Address - Fax:425-831-2170
Practice Address - Street 1:145 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8144
Practice Address - Country:US
Practice Address - Phone:425-888-1670
Practice Address - Fax:425-831-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty