Provider Demographics
NPI:1811453921
Name:EASTSIDE IDEAL HEALTH ISSAQUAH, PLLC
Entity type:Organization
Organization Name:EASTSIDE IDEAL HEALTH ISSAQUAH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:425-800-6881
Mailing Address - Street 1:1525 NW MALL ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8947
Mailing Address - Country:US
Mailing Address - Phone:425-800-6881
Mailing Address - Fax:425-392-1039
Practice Address - Street 1:1495 NW GILMAN BLVD STE 12
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5328
Practice Address - Country:US
Practice Address - Phone:425-800-6881
Practice Address - Fax:425-392-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty