Provider Demographics
NPI:1669139028
Name:WLODAWER, JOANNA (DC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WLODAWER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E CASINO RD STE B7
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2600
Mailing Address - Country:US
Mailing Address - Phone:425-512-8044
Mailing Address - Fax:
Practice Address - Street 1:205 E CASINO RD STE B7
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2600
Practice Address - Country:US
Practice Address - Phone:425-512-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60287011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor