Healthcare Provider Details

I. General information

NPI: 1538645288
Provider Name (Legal Business Name): FUNCTIONAL HEALTH CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE STE 104
SEATTLE WA
98105-8667
US

IV. Provider business mailing address

15 SW EVERETT MALL WAY STE G
EVERETT WA
98204-2715
US

V. Phone/Fax

Practice location:
  • Phone: 206-315-7998
  • Fax: 206-316-2308
Mailing address:
  • Phone: 425-355-5222
  • Fax: 425-355-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE TROXLER
Title or Position: BILLING SPECIALIST
Credential:
Phone: 425-355-5222