Provider Demographics
NPI:1841656386
Name:AMAZING LIFE CHIROPRACTIC & WELLNESS PLLC
Entity type:Organization
Organization Name:AMAZING LIFE CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOCHELAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-737-5343
Mailing Address - Street 1:800 164TH ST SE STE O
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6301
Mailing Address - Country:US
Mailing Address - Phone:425-737-5343
Mailing Address - Fax:
Practice Address - Street 1:800 164TH ST SE STE O
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6301
Practice Address - Country:US
Practice Address - Phone:425-737-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60537297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty