Healthcare Provider Details

I. General information

NPI: 1881176170
Provider Name (Legal Business Name): CHIRPRACTIC WELLNESS AND REHAB CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32114 1ST AVE S STE 104
FEDERAL WAY WA
98003
US

IV. Provider business mailing address

32114 1ST AVE S STE 104
FEDERAL WAY WA
98003-5760
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-6101
  • Fax:
Mailing address:
  • Phone: 253-661-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALNOOR BHANJI
Title or Position: OWNER
Credential: DC
Phone: 253-431-5343