Provider Demographics
NPI:1336375393
Name:DAVID L. VLASUK D.C, P.C.
Entity Type:Organization
Organization Name:DAVID L. VLASUK D.C, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:VLASUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-455-9580
Mailing Address - Street 1:1750 112TH AVE NE
Mailing Address - Street 2:STE E-163
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3752
Mailing Address - Country:US
Mailing Address - Phone:425-455-9580
Mailing Address - Fax:
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:STE E-163
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:425-455-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217000832Medicare PIN