Healthcare Provider Details

I. General information

NPI: 1629636709
Provider Name (Legal Business Name): JAD3 P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 WOODLAWN AVE NE
SEATTLE WA
98115-5433
US

IV. Provider business mailing address

7010 WOODLAWN AVE NE
SEATTLE WA
98115-5433
US

V. Phone/Fax

Practice location:
  • Phone: 206-517-5433
  • Fax: 206-517-5533
Mailing address:
  • Phone: 206-517-5433
  • Fax: 206-517-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NIALL C DILLAN
Title or Position: PRESIDENT
Credential: DC
Phone: 206-517-5433