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General NPI Number Information
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NPI Number | 1801156179
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Entity Type | Organization
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Legal Business Name | STEFAN BLACK DC LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 8827 31ST AVE SW # 1
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City | SEATTLE
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State | WA
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Zip | 98126-3718
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Country | US
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Telephone | 206-841-4031
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Fax |
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Provider Business Mailing Address
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Address Line | 8827 31ST AVE SW
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City | SEATTLE
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State | WA
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Zip | 98126-3718
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Country | US
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Telephone | 206-841-4031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEFAN RICHARD BLACK
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Credential | D.C.
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Telephone | 206-841-4031
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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 | CH00034220
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License Number State | WA
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