Provider Demographics
NPI:1740821461
Name:PLATEAU CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PLATEAU CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-985-4629
Mailing Address - Street 1:4425 ISSAQUAH PINE LAKE RD SE APT A22
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-5254
Mailing Address - Country:US
Mailing Address - Phone:425-985-4629
Mailing Address - Fax:
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:425-868-9593
Practice Address - Fax:425-868-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty