Provider Demographics
NPI:1982062030
Name:SONG, HAEJO (ND, DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:HAEJO
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:ND, DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16911 HIGHWAY 99 STE 105
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3104
Mailing Address - Country:US
Mailing Address - Phone:425-588-3838
Mailing Address - Fax:
Practice Address - Street 1:16911 HIGHWAY 99 STE 105
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3104
Practice Address - Country:US
Practice Address - Phone:425-588-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60621348111N00000X
171100000X
WANT61490181175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist