MEDICARE: CALVIN MULANAX DC CORP

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	111NS0005X	Sports Physician Chiropractor	CH00034853	WA

General Provider Information

NPI Number	:	1548684988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVIN MULANAX DC CORP

Provider Business Mailing Address
First Line	:	2722 EASTLAKE AVE E STE 360
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3143
Country	:	US
Telephone Number	:	206-324-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 EASTLAKE AVE E STE 360
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3143
Country	:	US
Telephone Number	:	206-324-8600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CALVIN MULANAX
Credential	:	DC
Telephone Number	:	206-324-8600

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	02/05/2014

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