=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497193072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUGHES CHIROPRACTIC AND MASSAGE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2013
-----------------------------------------------------
Last Update Date | 06/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 BRONSON WAY N SUITE 120
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-271-4543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 BRONSON WAY N 120
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-271-4543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TRISHA J HUGHES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 425-271-4543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00034499
-----------------------------------------------------
License Number State |
-----------------------------------------------------