Healthcare Provider Details

I. General information

NPI: 1033482559
Provider Name (Legal Business Name): FAST BRAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5712 E LAKE SAMMAMISH PKWY SE STE 106
ISSAQUAH WA
98029-8943
US

IV. Provider business mailing address

1607 24TH AVE NE
ISSAQUAH WA
98029-7367
US

V. Phone/Fax

Practice location:
  • Phone: 425-518-9077
  • Fax:
Mailing address:
  • Phone: 425-518-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH00003657
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60096656
License Number State

VIII. Authorized Official

Name: DR. DAVID WILLIAM BURNS
Title or Position: OWNER
Credential: DC, ND
Phone: 425-518-9077