Provider Demographics
NPI:1811099955
Name:CHAN, MICHAEL W (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:CHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14136
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-0136
Mailing Address - Country:US
Mailing Address - Phone:206-233-0818
Mailing Address - Fax:206-292-9340
Practice Address - Street 1:608 8TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-233-0818
Practice Address - Fax:206-292-9340
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82280Medicare UPIN
GAB17753Medicare ID - Type Unspecified