Provider Demographics
NPI:1205489267
Name:SHEPHERD FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SHEPHERD FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:206-691-1800
Mailing Address - Street 1:1500 WESTLAKE AVE N STE 118
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3036
Mailing Address - Country:US
Mailing Address - Phone:206-691-1800
Mailing Address - Fax:206-691-1810
Practice Address - Street 1:1500 WESTLAKE AVE N STE 118
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3036
Practice Address - Country:US
Practice Address - Phone:206-691-1800
Practice Address - Fax:206-691-1810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPHERD FAMILY CHIROPRACITC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center