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General NPI Number Information
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NPI Number | 1023337862
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Entity Type | Organization
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Legal Business Name | ACTIVE SEATTLE CHIROPRACTIC AND SPORTS THERAPY PLLC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 2366 EASTLAKE AVE E SUITE 333
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City | SEATTLE
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State | WA
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Zip | 98102-3366
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Country | US
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Telephone | 206-420-7926
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Fax | 206-458-6072
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Provider Business Mailing Address
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Address Line | 2366 EASTLAKE AVE E SUITE 429
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City | SEATTLE
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State | WA
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Zip | 98102-3366
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Country | US
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Telephone | 206-420-7926
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Fax | 206-458-6072
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER/PRESIDENT
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Name | DR. NATASHA NADINE WHITTAKER
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Credential | BSC, BS, DC, CSCS
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Telephone | 206-420-7926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00034767
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License Number State | WA
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