Healthcare Provider Details

I. General information

NPI: 1669747812
Provider Name (Legal Business Name): SHERWOOD CHIROPRACTIC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E SUNSET WAY
ISSAQUAH WA
98027-3440
US

IV. Provider business mailing address

435 E SUNSET WAY
ISSAQUAH WA
98027-3440
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-4792
  • Fax: 425-837-0311
Mailing address:
  • Phone: 425-392-4792
  • Fax: 425-837-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00002595
License Number StateWA

VIII. Authorized Official

Name: DR. MARK EDWARD SHERWOOD
Title or Position: PRESIDENT
Credential: DC
Phone: 425-392-4792