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General NPI Number Information
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NPI Number | 1275953648
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Entity Type | Organization
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Legal Business Name | ALLIANCE COMMUNITY CLINIC
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 16005 INTERNATIONAL BLVD STE A
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City | SEATAC
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State | WA
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Zip | 98188-2651
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Country | US
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Telephone | 206-569-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 16005 INTERNATIONAL BLVD STE A
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City | SEATAC
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State | WA
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Zip | 98188-2651
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Country | US
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Telephone | 206-569-5756
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH AYELE
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Credential | DC
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Telephone | 206-769-5756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 60218125
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License Number State | WA
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