Healthcare Provider Details

I. General information

NPI: 1366531758
Provider Name (Legal Business Name): SIK CHI STANLEY CHAN L.AC. LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33710 9TH AVE S STE 2
FEDERAL WAY WA
98003-6734
US

IV. Provider business mailing address

33710 9TH AVE S STE 1
FEDERAL WAY WA
98003-6734
US

V. Phone/Fax

Practice location:
  • Phone: 206-228-0479
  • Fax: 888-328-1218
Mailing address:
  • Phone: 206-228-0479
  • Fax: 888-328-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00001891
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00014480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: