Healthcare Provider Details

I. General information

NPI: 1396472494
Provider Name (Legal Business Name): LEGACY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

IV. Provider business mailing address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-1100
  • Fax: 253-840-1199
Mailing address:
  • Phone: 253-840-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK MCVEIGH
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 253-840-1100