Healthcare Provider Details

I. General information

NPI: 1235474974
Provider Name (Legal Business Name): OPTIMUM ACUPUNCTURE & CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 NE 65TH ST
SEATTLE WA
98115-6412
US

IV. Provider business mailing address

506 NE 65TH ST
SEATTLE WA
98115-6412
US

V. Phone/Fax

Practice location:
  • Phone: 206-547-3127
  • Fax: 206-547-8525
Mailing address:
  • Phone: 206-547-3127
  • Fax: 206-547-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0004419084
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0009829807
License Number StateWA

VIII. Authorized Official

Name: CHRISTINE ALAINE MESHEW
Title or Position: OWNER
Credential: D.C., M.A.
Phone: 206-399-9303