Provider Demographics
NPI:1912241662
Name:TRIFECTA PLLC
Entity Type:Organization
Organization Name:TRIFECTA PLLC
Other - Org Name:SEATAC SPINE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHUMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-246-8830
Mailing Address - Street 1:16704 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3116
Mailing Address - Country:US
Mailing Address - Phone:206-246-8830
Mailing Address - Fax:
Practice Address - Street 1:16704 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-3116
Practice Address - Country:US
Practice Address - Phone:206-246-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60071763111N00000X
WACH60070223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty