MEDICARE: DR. DAVID PAUL JACHIM PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY00001916	WA
2	103TP0814X	Psychoanalysis Psychologist	PY00001916	WA

General Provider Information

NPI Number	:	1194892539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL JACHIM PH.D.

Provider Business Mailing Address
First Line	:	216 1ST AVE S
Second Line	:	SUITE 360
City	:	SEATTLE
State	:	WA
Zip	:	98104-3441
Country	:	US
Telephone Number	:	206-728-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 1ST AVE S
Second Line	:	SUITE 360
City	:	SEATTLE
State	:	WA
Zip	:	98104-3441
Country	:	US
Telephone Number	:	206-728-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/04/2010

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