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General NPI Number Information
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NPI Number | 1194082396
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Entity Type | Organization
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Legal Business Name | FIRST STEP SPINE AND WELLNESS, LLC
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 12006 98TH AVE NE
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City | KIRKLAND
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State | WA
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Zip | 98034-4218
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Country | US
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Telephone | 425-394-3991
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Fax |
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Provider Business Mailing Address
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Address Line | 13397 PROSPECTOR RIDGE RD SE
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City | MONROE
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State | WA
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Zip | 98272-2835
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Country | US
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Telephone | 425-394-3991
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JEREMIAH LEE TIBBITTS
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Credential | DC
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Telephone | 425-394-3991
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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 | CH00034810
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License Number State | WA
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