MEDICARE: ELEMENT SPORTS PERFORMANCE

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	111NS0005X	Sports Physician Chiropractor

General Provider Information

NPI Number	:	1467843060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENT SPORTS PERFORMANCE

Provider Business Mailing Address
First Line	:	2520 WESTLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2234
Country	:	US
Telephone Number	:	206-399-2708
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 WESTLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2234
Country	:	US
Telephone Number	:	206-399-2708
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER YOUNG
Credential	:
Telephone Number	:	206-399-2708

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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Directions to “ELEMENT SPORTS PERFORMANCE ” Practice Location

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