Provider Demographics
NPI:1801071576
Name:NORTHWEST CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:NORTHWEST CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:RUSNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-429-2922
Mailing Address - Street 1:19655 1ST AVE S
Mailing Address - Street 2:#205
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2166
Mailing Address - Country:US
Mailing Address - Phone:206-429-2922
Mailing Address - Fax:206-429-2422
Practice Address - Street 1:19655 1ST AVE S
Practice Address - Street 2:#205
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2166
Practice Address - Country:US
Practice Address - Phone:206-429-2922
Practice Address - Fax:206-429-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034720111N00000X
WACH00034734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8870621Medicare PIN