Provider Demographics
NPI:1851583348
Name:PREMIER CHIROPRACTIC 5 PLLC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC 5 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-614-4000
Mailing Address - Street 1:6415 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1871
Mailing Address - Country:US
Mailing Address - Phone:206-938-2285
Mailing Address - Fax:206-938-4219
Practice Address - Street 1:6415 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1871
Practice Address - Country:US
Practice Address - Phone:206-938-2285
Practice Address - Fax:206-938-4219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER CHIROPRACTIC & MASSAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034182111N00000X
WAMA00021456225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8858291Medicare PIN