Provider Demographics
NPI:1831323609
Name:WRIGHT LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:WRIGHT LIFE CHIROPRACTIC
Other - Org Name:PREMIER CHIROPRACTIC #4 PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:425-614-4000
Mailing Address - Street 1:1299 156TH AVE NE
Mailing Address - Street 2:123
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4599
Mailing Address - Country:US
Mailing Address - Phone:425-614-4000
Mailing Address - Fax:425-641-0880
Practice Address - Street 1:1299 156TH AVE NE
Practice Address - Street 2:123
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4599
Practice Address - Country:US
Practice Address - Phone:425-614-4000
Practice Address - Fax:425-641-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602866819000OtherUBI #