Provider Demographics
NPI:1700965563
Name:PRENTICE FAMILY CHIROPRACTIC INC PS
Entity Type:Organization
Organization Name:PRENTICE FAMILY CHIROPRACTIC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PRENTICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-820-5888
Mailing Address - Street 1:13904 100TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5231
Mailing Address - Country:US
Mailing Address - Phone:425-820-5888
Mailing Address - Fax:425-820-5022
Practice Address - Street 1:13904 100TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5231
Practice Address - Country:US
Practice Address - Phone:425-820-5888
Practice Address - Fax:425-820-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB10788Medicare ID - Type Unspecified