Provider Demographics
NPI:1790182517
Name:BEALS, KORRIN (LMT, LMP)
Entity type:Individual
Prefix:
First Name:KORRIN
Middle Name:
Last Name:BEALS
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 STONE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8017
Mailing Address - Country:US
Mailing Address - Phone:206-588-0014
Mailing Address - Fax:206-577-3599
Practice Address - Street 1:3933 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8017
Practice Address - Country:US
Practice Address - Phone:206-588-0014
Practice Address - Fax:206-577-3599
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60483443111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner