=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114688298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH WORKS CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2021
-----------------------------------------------------
Last Update Date | 12/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 BENSON RD S STE 102
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-623-2443
-----------------------------------------------------
Fax | 425-249-7175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3354
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98009-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-305-4337
-----------------------------------------------------
Fax | 425-249-7175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JANELLE LA'VETTE CLAYTON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 425-305-4337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------