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General NPI Number Information
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NPI Number | 1689728453
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Entity Type | Organization
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Legal Business Name | PURE CHIROPRACTIC 1 PLLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 15015 MAIN ST SUITE 106
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City | BELLEVUE
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State | WA
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Zip | 98007-5229
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Country | US
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Telephone | 425-643-4454
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Fax |
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Provider Business Mailing Address
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Address Line | 15015 MAIN ST SUITE 106
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City | BELLEVUE
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State | WA
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Zip | 98007-5229
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Country | US
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Telephone | 425-643-4454
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JEREMY JOHN WELCH
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Credential | D,C,
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Telephone | 425-643-4454
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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 | WA
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