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General NPI Number Information
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NPI Number | 1467592741
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Entity Type | Organization
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Legal Business Name | LAKE STEVENS CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 905 STATE ROUTE 9 NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-9484
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Country | US
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Telephone | 425-334-5066
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Fax | 425-335-4787
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Provider Business Mailing Address
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Address Line | 905 SR 9 NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-9484
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Country | US
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Telephone | 425-334-5066
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Fax | 425-335-4787
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Authorized Official
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Title or Position | OWNER
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Name | PETER HANSON
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Credential | DC
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Telephone | 425-334-5066
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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 | CH00001249
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0002638
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00000734
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License Number State | WA
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