Provider Demographics
NPI:1770900847
Name:VELO SPORTS REHAB CORP
Entity type:Organization
Organization Name:VELO SPORTS REHAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-590-9208
Mailing Address - Street 1:1940 116TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3097
Mailing Address - Country:US
Mailing Address - Phone:425-590-9208
Mailing Address - Fax:
Practice Address - Street 1:1940 116TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3097
Practice Address - Country:US
Practice Address - Phone:425-590-9208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034592111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty