Healthcare Provider Details

I. General information

NPI: 1346873445
Provider Name (Legal Business Name): JEREMIAH ADEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 47TH ST STE 101
SEATTLE WA
98105-4685
US

IV. Provider business mailing address

3023 1ST AVE APT 506
SEATTLE WA
98121-1064
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-0123
  • Fax: 206-527-0133
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number60916879
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: