Healthcare Provider Details

I. General information

NPI: 1851583348
Provider Name (Legal Business Name): PREMIER CHIROPRACTIC 5 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 FAUNTLEROY WAY SW
SEATTLE WA
98136-1871
US

IV. Provider business mailing address

6415 FAUNTLEROY WAY SW
SEATTLE WA
98136-1871
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-2285
  • Fax: 206-938-4219
Mailing address:
  • Phone: 206-938-2285
  • Fax: 206-938-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034182
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021456
License Number StateWA

VIII. Authorized Official

Name: LILLY HANSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-614-4000