Healthcare Provider Details

I. General information

NPI: 1568737047
Provider Name (Legal Business Name): PAIN FREE MOVE WELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21907 64TH AVE W STE 110
MOUNTLAKE TERRACE WA
98043-2298
US

IV. Provider business mailing address

21907 64TH AVE W STE 110
MOUNTLAKE TERRACE WA
98043-2298
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-6876
  • Fax: 425-775-2739
Mailing address:
  • Phone: 425-774-6876
  • Fax: 425-775-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034535
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL WARREN GROVES
Title or Position: PRESIDENT
Credential: D.C.
Phone: 425-802-3391