Provider Demographics
NPI:1942855499
Name:REDMOND BACK & NECK CARE CLINIC
Entity Type:Organization
Organization Name:REDMOND BACK & NECK CARE CLINIC
Other - Org Name:REDMOND BACK & NECK PAIN CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WAGENER DEWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-885-9950
Mailing Address - Street 1:16440 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3613
Mailing Address - Country:US
Mailing Address - Phone:425-885-9950
Mailing Address - Fax:425-895-9766
Practice Address - Street 1:16440 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3613
Practice Address - Country:US
Practice Address - Phone:425-885-9950
Practice Address - Fax:425-895-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty