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General NPI Number Information
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NPI Number | 1366631277
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Entity Type | Organization
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Legal Business Name | SUMMIT CHIROPRACTIC CORP. DBA UNIVERSITY CHIROPRACTIC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 8221 5TH AVE NE STE 1
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City | SEATTLE
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State | WA
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Zip | 98115-4190
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Country | US
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Telephone | 206-525-2811
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Fax | 206-525-2812
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Provider Business Mailing Address
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Address Line | 8221 5TH AVE NE STE 1
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City | SEATTLE
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State | WA
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Zip | 98115-4190
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Country | US
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Telephone | 206-525-2811
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Fax | 206-525-2812
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND J SUE
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Credential | DC
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Telephone | 206-525-2811
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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 | 34105
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License Number State | WA
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