Provider Demographics
NPI:1891935342
Name:SO, DENISE EVELYN (DC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:EVELYN
Last Name:SO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
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:425-672-8695
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:425-672-8695
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60079488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH60079488OtherWASHINGTON LICENSE