Healthcare Provider Details

I. General information

NPI: 1942855499
Provider Name (Legal Business Name): REDMOND BACK & NECK CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16440 NE 85TH ST
REDMOND WA
98052-3613
US

IV. Provider business mailing address

16440 NE 85TH ST
REDMOND WA
98052-3613
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-9950
  • Fax: 425-895-9766
Mailing address:
  • Phone: 425-885-9950
  • Fax: 425-895-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHARON T WAGENER DEWOLF
Title or Position: PROVIDER/OWNER
Credential: DC
Phone: 425-885-9950