Provider Demographics
NPI:1912424466
Name:SOUDER, JOHN MICHAEL (LMP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:SOUDER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 NORTHWEST AVE.
Mailing Address - Street 2:BELLINGHAM SPINE AND DISC
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-715-8722
Mailing Address - Fax:866-568-1992
Practice Address - Street 1:2701 NORTHWEST AVE.
Practice Address - Street 2:BELLINGHAM SPINE AND DISC
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-715-8722
Practice Address - Fax:866-568-1992
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60599999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist