MEDICARE: PINE LAKE CHIROPRACTIC CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002143	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356433726	OTHER	WA	DAVID BAHM NPI
2	0038178	OTHER	WA	L AND I
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225159940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE LAKE CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	2908 228TH AVE SE
Second Line	:	SUITE C
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9306
Country	:	US
Telephone Number	:	425-391-4095
Fax Number	:	425-391-6059

Provider Business Practice Location Address
First Line	:	2908 228TH AVE SE
Second Line	:	SUITE C
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9306
Country	:	US
Telephone Number	:	425-391-4095
Fax Number	:	425-391-6059

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID EMIL BAHM
Credential	:	D.C.
Telephone Number	:	425-391-4095

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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Directions to “PINE LAKE CHIROPRACTIC CLINIC INC ” Practice Location

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