Provider Demographics
NPI:1831306463
Name:ADVANCED SPINAL REHAB
Entity Type:Organization
Organization Name:ADVANCED SPINAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-455-4038
Mailing Address - Street 1:1331 118TH AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3890
Mailing Address - Country:US
Mailing Address - Phone:425-455-4038
Mailing Address - Fax:
Practice Address - Street 1:1331 118TH AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3890
Practice Address - Country:US
Practice Address - Phone:425-455-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3669111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty