Provider Demographics
NPI:1992841738
Name:TREADWAY, JEFFERY DON (DC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DON
Last Name:TREADWAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22727 HWY 99
Mailing Address - Street 2:SUITE 109
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8381
Mailing Address - Country:US
Mailing Address - Phone:425-774-1090
Mailing Address - Fax:425-775-9797
Practice Address - Street 1:22727 HIGHWAY 99
Practice Address - Street 2:SUITE 109
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8381
Practice Address - Country:US
Practice Address - Phone:425-774-1090
Practice Address - Fax:425-775-9797
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH00002959OtherCHIROPRACTIC LICENSE NO.
WAU49356Medicare UPIN
WAG8801653Medicare ID - Type Unspecified