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General NPI Number Information
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NPI Number | 1972927606
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Entity Type | Organization
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Legal Business Name | JOHN R LOGAN
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 1001 BROADWAY SUITE 300
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City | SEATTLE
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State | WA
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Zip | 98122-4397
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Country | US
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Telephone | 206-622-2305
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 BROADWAY STE 300
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City | SEATTLE
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State | WA
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Zip | 98122-4304
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Country | US
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Telephone | 206-622-2305
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. JOHN R LOGAN
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Credential | D.C.
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Telephone | 206-622-2305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | CH00001025
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License Number State | WA
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