Healthcare Provider Details

I. General information

NPI: 1750656302
Provider Name (Legal Business Name): SEQUIM CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 5TH AVE STE 1
SEQUIM WA
98382-5062
US

IV. Provider business mailing address

625 N 5TH AVE STE 1
SEQUIM WA
98382-5062
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-8844
  • Fax:
Mailing address:
  • Phone: 360-683-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 60196521
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNDSAY JANE MISHKO
Title or Position: VICE PRESIDENT
Credential:
Phone: 360-683-8844