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General NPI Number Information
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NPI Number | 1851824197
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Entity Type | Organization
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Legal Business Name | FDSEATTLE CLINIC INC
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 918 S HORTON ST STE 930
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City | SEATTLE
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State | WA
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Zip | 98134-1952
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Country | US
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Telephone | 425-533-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 918 S HORTON ST STE 930
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City | SEATTLE
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State | WA
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Zip | 98134-1952
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Country | US
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Telephone | 425-533-2325
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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. CHANIL JUNG
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Credential | D.C.
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Telephone | 425-533-2325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH60415454
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License Number State | WA
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