Provider Demographics
NPI:1023337862
Name:ACTIVE SEATTLE CHIROPRACTIC AND SPORTS THERAPY PLLC
Entity type:Organization
Organization Name:ACTIVE SEATTLE CHIROPRACTIC AND SPORTS THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, BS, DC, CSCS
Authorized Official - Phone:206-420-7926
Mailing Address - Street 1:2366 EASTLAKE AVE E
Mailing Address - Street 2:SUITE 429
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3366
Mailing Address - Country:US
Mailing Address - Phone:206-420-7926
Mailing Address - Fax:206-458-6072
Practice Address - Street 1:2366 EASTLAKE AVE E
Practice Address - Street 2:SUITE 333
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3366
Practice Address - Country:US
Practice Address - Phone:206-420-7926
Practice Address - Fax:206-458-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty