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General NPI Number Information
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NPI Number | 1033492285
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Entity Type | Organization
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Legal Business Name | EVIDENCE BASED HEALTHCARE, PLLC
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 910 LENORA ST SUITE 160
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City | SEATTLE
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State | WA
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Zip | 98121-2754
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Country | US
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Telephone | 206-397-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 910 LENORA ST SUITE 160
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City | SEATTLE
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State | WA
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Zip | 98121-2754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN J FAVREAU
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Credential | DC
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Telephone | 206-397-3457
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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 | CH00034786
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License Number State | WA
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