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General NPI Number Information
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NPI Number | 1225262983
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Entity Type | Organization
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Legal Business Name | PREMIER CHIROPRACTIC #1, PLLC
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 19800 INTERNATIONAL BLVD STE A
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City | SEATAC
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State | WA
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Zip | 98188-5470
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Country | US
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Telephone | 206-878-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 19800 INTERNATIONAL BLVD STE A
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City | SEATAC
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State | WA
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Zip | 98188-5470
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Country | US
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Telephone | 206-878-8888
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DANA VERGHETTI
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Credential |
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Telephone | 253-677-3711
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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 | CH2156
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License Number State | WA
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