Healthcare Provider Details

I. General information

NPI: 1538421292
Provider Name (Legal Business Name): SODO HEALTH & PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 6TH AVE S
SEATTLE WA
98134-2104
US

IV. Provider business mailing address

2920 6TH AVE S
SEATTLE WA
98134-2104
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-7943
  • Fax: 206-932-8686
Mailing address:
  • Phone: 206-932-7943
  • Fax: 206-932-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003319
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023542
License Number StateWA

VIII. Authorized Official

Name: DR. MICHAEL ROSS
Title or Position: OWNER
Credential: D.C.
Phone: 206-932-7943