Provider Demographics
NPI:1669779419
Name:UPTON CHIROPRACTIC
Entity type:Organization
Organization Name:UPTON CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-427-0809
Mailing Address - Street 1:1836 25 AVE. NE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029
Mailing Address - Country:US
Mailing Address - Phone:425-427-0809
Mailing Address - Fax:425-427-8619
Practice Address - Street 1:1836 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-2613
Practice Address - Country:US
Practice Address - Phone:425-427-0809
Practice Address - Fax:425-427-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8890944Medicare PIN