MEDICARE: DOWNTOWN SEATTLE CHIROPRACTIC CENTER INC PS

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	3507	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RU5213	OTHER	WA	REGENCE
2	126621	OTHER	WA	L & I

General Provider Information

NPI Number	:	1316922495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNTOWN SEATTLE CHIROPRACTIC CENTER INC PS

Provider Business Mailing Address
First Line	:	509 OLIVE WAY
Second Line	:	STE 1348
City	:	SEATTLE
State	:	WA
Zip	:	98101-1720
Country	:	US
Telephone Number	:	206-682-5885
Fax Number	:	206-467-1453

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY
Second Line	:	STE 1348
City	:	SEATTLE
State	:	WA
Zip	:	98101-1720
Country	:	US
Telephone Number	:	206-682-5885
Fax Number	:	206-467-1453

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISA M RUIZ
Credential	:	DC
Telephone Number	:	206-682-5885

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	08/22/2020

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