Healthcare Provider Details

I. General information

NPI: 1881883460
Provider Name (Legal Business Name): WELLNESSONE OF EASTGATE, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 NE 8TH ST STE 115
BELLEVUE WA
98007-4115
US

IV. Provider business mailing address

14700 NE 8TH ST STE 115
BELLEVUE WA
98007-4115
US

V. Phone/Fax

Practice location:
  • Phone: 425-289-0092
  • Fax: 425-644-2560
Mailing address:
  • Phone: 425-644-8386
  • Fax: 425-644-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003604
License Number StateWA

VIII. Authorized Official

Name: STEVEN PAULL THAIN
Title or Position: PRESIDENT
Credential: DC
Phone: 425-289-0092