Provider Demographics
NPI:1851824197
Name:FDSEATTLE CLINIC INC
Entity Type:Organization
Organization Name:FDSEATTLE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-533-2325
Mailing Address - Street 1:918 S HORTON ST
Mailing Address - Street 2:STE 930
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1952
Mailing Address - Country:US
Mailing Address - Phone:425-533-2325
Mailing Address - Fax:
Practice Address - Street 1:918 S HORTON ST
Practice Address - Street 2:STE 930
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1952
Practice Address - Country:US
Practice Address - Phone:425-533-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60415454111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty