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General NPI Number Information
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NPI Number | 1558586487
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Entity Type | Organization
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Legal Business Name | FAIRWOOD CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 14410 SE PETROVITSKY RD STE 109
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City | RENTON
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State | WA
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Zip | 98058-8900
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Country | US
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Telephone | 425-226-1856
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Fax | 425-226-0231
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Provider Business Mailing Address
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Address Line | 14410 SE PETROVITSKY RD STE 109
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City | RENTON
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State | WA
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Zip | 98058-8900
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Country | US
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Telephone | 425-226-1856
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Fax | 425-226-0231
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN THOMAS RYAN
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Credential | DC
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Telephone | 425-226-1856
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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 | CH00001828
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License Number State | WA
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