Provider Demographics
NPI:1922563782
Name:SEATTLE NORTHEAST CHIROPRACTIC
Entity Type:Organization
Organization Name:SEATTLE NORTHEAST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHONG
Authorized Official - Middle Name:IL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-747-6942
Mailing Address - Street 1:11734 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5026
Mailing Address - Country:US
Mailing Address - Phone:206-364-9501
Mailing Address - Fax:
Practice Address - Street 1:11734 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5026
Practice Address - Country:US
Practice Address - Phone:206-364-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty