Provider Demographics
NPI:1871641977
Name:SEEPERSAD, NICHOLE R (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:R
Last Name:SEEPERSAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 45TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1625
Mailing Address - Country:US
Mailing Address - Phone:510-415-8801
Mailing Address - Fax:
Practice Address - Street 1:17530 NE UNION HILL RD
Practice Address - Street 2:SUITE 270
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3387
Practice Address - Country:US
Practice Address - Phone:425-558-1266
Practice Address - Fax:425-558-9549
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor