Healthcare Provider Details

I. General information

NPI: 1205028826
Provider Name (Legal Business Name): PREMIER CHIROPRACTIC 4 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 156TH AVE NE STE 123
BELLEVUE WA
98007-7562
US

IV. Provider business mailing address

1299 156TH AVE NE STE 123
BELLEVUE WA
98007-7562
US

V. Phone/Fax

Practice location:
  • Phone: 425-614-4000
  • Fax: 425-641-0880
Mailing address:
  • Phone: 425-614-4000
  • Fax: 425-641-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00013538
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034325
License Number StateWA

VIII. Authorized Official

Name: MRS. LILLY HANSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-614-4000