Provider Demographics
NPI:1740480623
Name:MARKET PLACE CHIROPRACTIC, PS
Entity type:Organization
Organization Name:MARKET PLACE CHIROPRACTIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-441-0109
Mailing Address - Street 1:2107 ELLIOTT AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2186
Mailing Address - Country:US
Mailing Address - Phone:206-441-0109
Mailing Address - Fax:206-441-3021
Practice Address - Street 1:2107 ELLIOTT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2186
Practice Address - Country:US
Practice Address - Phone:206-441-0109
Practice Address - Fax:206-441-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033755261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty