Provider Demographics
NPI:1457132839
Name:CORE ACCIDENT & INJURY CLINIC LLC
Entity type:Organization
Organization Name:CORE ACCIDENT & INJURY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT/CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:SKYE
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:425-471-4083
Mailing Address - Street 1:22727 HWY 99
Mailing Address - Street 2:STE 205
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22727 HWY 99 STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-471-4083
Practice Address - Fax:425-577-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty