=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528659927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE FAMILY WELLNESS CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2021
-----------------------------------------------------
Last Update Date | 03/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17410 HIGHWAY 99 STE 150
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98037-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-741-9927
-----------------------------------------------------
Fax | 425-741-0465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17410 HIGHWAY 99 STE 150
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98037-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-741-9927
-----------------------------------------------------
Fax | 425-741-0465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SANG CHO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 425-741-9927
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------