Provider Demographics
NPI:1649725284
Name:SEED OF LIFE CHIROPRACTIC AND WELLNESS, LLC
Entity type:Organization
Organization Name:SEED OF LIFE CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARONROSE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAMELAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-341-4085
Mailing Address - Street 1:753 N 35TH ST STE 108F
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8889
Mailing Address - Country:US
Mailing Address - Phone:206-565-9691
Mailing Address - Fax:
Practice Address - Street 1:753 N 35TH ST STE 108F
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8889
Practice Address - Country:US
Practice Address - Phone:206-565-9691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60654257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty