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General NPI Number Information
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NPI Number | 1336437250
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Entity Type | Organization
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Legal Business Name | WEST SEATTLE NEIGHBORHOOD CHIROPRACTIC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 2140 CALIFORNIA AVE SW
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City | SEATTLE
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State | WA
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Zip | 98116-2164
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Country | US
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Telephone | 206-659-0771
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Fax | 206-659-0784
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Provider Business Mailing Address
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Address Line | 2140 CALIFORNIA AVE SW
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City | SEATTLE
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State | WA
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Zip | 98116-2164
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Country | US
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Telephone | 206-659-0771
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Fax | 206-659-0784
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. CAROLYN J FANCHER
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Credential | D.C.
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Telephone | 206-659-0771
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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 | CH00034883
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License Number State | WA
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