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General NPI Number Information
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NPI Number | 1649440918
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Entity Type | Organization
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Legal Business Name | GREEN LAKE CHIROPRACTIC & NUTRITIONAL HEALING LLC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 1408 N 80TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-4421
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Country | US
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Telephone | 206-523-0121
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Fax | 206-523-0341
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Provider Business Mailing Address
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Address Line | 1408 N 80TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-4421
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Country | US
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Telephone | 206-523-0121
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Fax | 206-523-0341
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN POLENZ
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Credential | DC
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Telephone | 206-523-0121
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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 |
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License Number State |
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