Provider Demographics
NPI:1336348572
Name:AVANT CHIROPRACTIC
Entity Type:Organization
Organization Name:AVANT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MACKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-826-1005
Mailing Address - Street 1:3611 WOODLAND PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7905
Mailing Address - Country:US
Mailing Address - Phone:206-826-1005
Mailing Address - Fax:206-826-1289
Practice Address - Street 1:3611 WOODLAND PARK AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7905
Practice Address - Country:US
Practice Address - Phone:206-826-1005
Practice Address - Fax:206-826-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0173323OtherLABOR & INDUSTRIES
WA0173323OtherLABOR & INDUSTRIES