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General NPI Number Information
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NPI Number | 1386920171
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Entity Type | Organization
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Legal Business Name | DR JUSTIN J FAVREAU PLLC
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 1225 DEXTER AVE N
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City | SEATTLE
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State | WA
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Zip | 98109-3518
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Country | US
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Telephone | 206-497-4962
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Fax | 206-316-8655
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Provider Business Mailing Address
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Address Line | 1225 DEXTER AVE N
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City | SEATTLE
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State | WA
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Zip | 98109-3518
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Country | US
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Telephone | 206-497-4962
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Fax | 206-316-8655
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Authorized Official
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Title or Position | PRESIDENT/CLINIC DIRECTOR
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Name | DR. JUSTIN JOHN FAVREAU
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Credential | D.C.
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Telephone | 206-497-4962
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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 | CH00034786
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License Number State | WA
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