Healthcare Provider Details

I. General information

NPI: 1871641977
Provider Name (Legal Business Name): NICHOLE R SEEPERSAD DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17530 NE UNION HILL RD SUITE 270
REDMOND WA
98052-3387
US

IV. Provider business mailing address

1623 45TH AVE SW
SEATTLE WA
98116-1625
US

V. Phone/Fax

Practice location:
  • Phone: 425-558-1266
  • Fax: 425-558-9549
Mailing address:
  • Phone: 510-415-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: