Healthcare Provider Details

I. General information

NPI: 1699216150
Provider Name (Legal Business Name): HYBRID CHIROPRACTIC SPORTS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19031 33RD AVE W 315
LYNNWOOD WA
98036-4731
US

IV. Provider business mailing address

19031 33RD AVE W 315
LYNNWOOD WA
98036-4731
US

V. Phone/Fax

Practice location:
  • Phone: 425-971-1942
  • Fax:
Mailing address:
  • Phone: 425-971-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number60630792
License Number StateWA

VIII. Authorized Official

Name: DR. JAYSON ADAM SIPRESS
Title or Position: OWNER
Credential: DC
Phone: 425-971-1942