MEDICARE: VANQUAETHEM CHIROPRACTIC AT MADISON PARK, 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	CH00033902	WA

General Provider Information

NPI Number	:	1912107624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANQUAETHEM CHIROPRACTIC AT MADISON PARK, INC.

Provider Business Mailing Address
First Line	:	4105 E MADISON ST
Second Line	:	SUITE 2
City	:	SEATTLE
State	:	WA
Zip	:	98112-3291
Country	:	US
Telephone Number	:	206-726-9595
Fax Number	:	206-320-1468

Provider Business Practice Location Address
First Line	:	4105 E MADISON ST
Second Line	:	SUITE 2
City	:	SEATTLE
State	:	WA
Zip	:	98112-3291
Country	:	US
Telephone Number	:	206-726-9595
Fax Number	:	206-320-1468

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. AMY S. VANQUAETHEM
Credential	:	D.C.
Telephone Number	:	206-726-9595

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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