Provider Demographics
NPI:1013200492
Name:ATHLETES PERFORMANCE CENTER PS
Entity type:Organization
Organization Name:ATHLETES PERFORMANCE CENTER PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURBONNAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-522-6240
Mailing Address - Street 1:7116 WOODLAWN AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5435
Mailing Address - Country:US
Mailing Address - Phone:206-522-6240
Mailing Address - Fax:206-926-7899
Practice Address - Street 1:4755 FAUNTLEROY WAY SW STE 120
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4669
Practice Address - Country:US
Practice Address - Phone:206-946-1323
Practice Address - Fax:206-926-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003244111N00000X
CH00034592111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty