Provider Demographics
NPI:1841225117
Name:CRESANTI, JOSEPH T (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:CRESANTI
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 1:626 164TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8116
Mailing Address - Country:US
Mailing Address - Phone:425-742-5400
Mailing Address - Fax:425-742-5447
Practice Address - Street 1:626 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8116
Practice Address - Country:US
Practice Address - Phone:425-742-5400
Practice Address - Fax:425-742-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB03416Medicare ID - Type Unspecified
WAU58998Medicare UPIN