MEDICARE: FDSEATTLE 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	111NS0005X	Sports Physician Chiropractor	CH60415454	WA

General Provider Information

NPI Number	:	1851824197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FDSEATTLE CLINIC INC

Provider Business Mailing Address
First Line	:	918 S HORTON ST
Second Line	:	STE 930
City	:	SEATTLE
State	:	WA
Zip	:	98134-1952
Country	:	US
Telephone Number	:	425-533-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 S HORTON ST
Second Line	:	STE 930
City	:	SEATTLE
State	:	WA
Zip	:	98134-1952
Country	:	US
Telephone Number	:	425-533-2325
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. CHANIL JUNG
Credential	:	D.C.
Telephone Number	:	425-533-2325

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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