Provider Demographics
NPI:1881968121
Name:SNOQUALMIE RIDGE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:SNOQUALMIE RIDGE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-396-5570
Mailing Address - Street 1:8026 DOUGLAS AVE SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-6313
Mailing Address - Country:US
Mailing Address - Phone:425-396-5570
Mailing Address - Fax:425-396-5580
Practice Address - Street 1:8026 DOUGLAS AVE SE
Practice Address - Street 2:SUITE 102
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6313
Practice Address - Country:US
Practice Address - Phone:425-396-5570
Practice Address - Fax:425-396-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0156366OtherLABOR AND INDUSTRIES
WAGAB33895Medicare PIN