Provider Demographics
NPI:1841566759
Name:EDMONDS FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EDMONDS FAMILY CHIROPRACTIC LLC
Other - Org Name:LIFE IS MOTION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-776-4224
Mailing Address - Street 1:8325 212TH ST SW STE 103
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7435
Mailing Address - Country:US
Mailing Address - Phone:425-776-4224
Mailing Address - Fax:
Practice Address - Street 1:8325 212TH ST SW STE 103
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7435
Practice Address - Country:US
Practice Address - Phone:425-776-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-25
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60036464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty