Provider Demographics
NPI:1801937115
Name:WEST BELLEVUE CHIROPRACTIC REHAB GROUP, PS
Entity type:Organization
Organization Name:WEST BELLEVUE CHIROPRACTIC REHAB GROUP, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMENEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-455-3700
Mailing Address - Street 1:10845 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6323
Mailing Address - Country:US
Mailing Address - Phone:425-455-3700
Mailing Address - Fax:425-462-7200
Practice Address - Street 1:10845 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6323
Practice Address - Country:US
Practice Address - Phone:425-455-3700
Practice Address - Fax:425-462-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002754261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center