=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629636709
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAD3 P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7010 WOODLAWN AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-517-5433
-----------------------------------------------------
Fax | 206-517-5533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7010 WOODLAWN AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-517-5433
-----------------------------------------------------
Fax | 206-517-5533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NIALL C DILLAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 206-517-5433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------