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General NPI Number Information
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NPI Number | 1417098005
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Entity Type | Organization
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Legal Business Name | WOODWAY CHIROPRACTIC AND MASSAGE, P.S.
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20015 HIGHWAY 99 STE A
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City | LYNNWOOD
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State | WA
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Zip | 98036-6073
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Country | US
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Telephone | 425-771-2225
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Fax | 425-670-8121
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Provider Business Mailing Address
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Address Line | 20015 HIGHWAY 99 STE A
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City | LYNNWOOD
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State | WA
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Zip | 98036-6073
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Country | US
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Telephone | 425-771-2225
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Fax | 425-670-8121
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | DR. MARK R. FREDRICH
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Credential | D.C.
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Telephone | 425-771-2225
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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 | CH00002873
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License Number State | WA
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