MEDICARE: DR. NICOLE MARIA TREDANARY D.C.

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	CH00003664	WA

General Provider Information

NPI Number	:	1467516047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE MARIA TREDANARY D.C.

Provider Business Mailing Address
First Line	:	4831 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4414
Country	:	US
Telephone Number	:	206-935-4500
Fax Number	:	206-938-0746

Provider Business Practice Location Address
First Line	:	4831 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4414
Country	:	US
Telephone Number	:	206-935-4500
Fax Number	:	206-938-0746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/09/2007

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