Provider Demographics
NPI:1336437250
Name:WEST SEATTLE NEIGHBORHOOD CHIROPRACTIC
Entity Type:Organization
Organization Name:WEST SEATTLE NEIGHBORHOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-659-0771
Mailing Address - Street 1:2140 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2164
Mailing Address - Country:US
Mailing Address - Phone:206-659-0771
Mailing Address - Fax:206-659-0784
Practice Address - Street 1:2140 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2164
Practice Address - Country:US
Practice Address - Phone:206-659-0771
Practice Address - Fax:206-659-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty