Provider Demographics
NPI:1376380881
Name:SEATTLE CHIROPRACTIC LIFE CENTER
Entity type:Organization
Organization Name:SEATTLE CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-352-8191
Mailing Address - Street 1:323 QUEEN ANNE AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4543
Mailing Address - Country:US
Mailing Address - Phone:206-352-8191
Mailing Address - Fax:206-456-4220
Practice Address - Street 1:323 QUEEN ANNE AVE N STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4543
Practice Address - Country:US
Practice Address - Phone:206-352-8191
Practice Address - Fax:206-456-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty