Healthcare Provider Details

I. General information

NPI: 1134334261
Provider Name (Legal Business Name): ALLIANCE CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 EASTLAKE AVE E
SEATTLE WA
98102-3010
US

IV. Provider business mailing address

2946 EASTLAKE AVE E
SEATTLE WA
98102-3010
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-5500
  • Fax: 206-632-5601
Mailing address:
  • Phone: 206-632-5500
  • Fax: 206-632-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH00002609
License Number StateWA

VIII. Authorized Official

Name: DR. VIVIAN M. LEDESMA
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 206-632-5500