Provider Demographics
NPI:1922291699
Name:DEVINE CHIROPRACTIC AND REHAB CENTER
Entity Type:Organization
Organization Name:DEVINE CHIROPRACTIC AND REHAB CENTER
Other - Org Name:DEVINE CHIROPRACTIC AND REHAB CENTER, P.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-623-2225
Mailing Address - Street 1:104 PIKE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2010
Mailing Address - Country:US
Mailing Address - Phone:206-623-2225
Mailing Address - Fax:206-686-7246
Practice Address - Street 1:104 PIKE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2010
Practice Address - Country:US
Practice Address - Phone:206-623-2225
Practice Address - Fax:206-686-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528133105OtherNPI
WAG8859516Medicare PIN