Provider Demographics
NPI:1184756777
Name:BACKSTROM, GUY DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:DOUGLAS
Last Name:BACKSTROM
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 1:8105 166TH AVE NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3999
Mailing Address - Country:US
Mailing Address - Phone:525-885-6633
Mailing Address - Fax:
Practice Address - Street 1:8105 166TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3999
Practice Address - Country:US
Practice Address - Phone:525-885-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor