Provider Demographics
NPI:1861738064
Name:TETUAN INNOVATIVE CHIROPRACTIC CARE P.S.
Entity type:Organization
Organization Name:TETUAN INNOVATIVE CHIROPRACTIC CARE P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:TETUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-455-3300
Mailing Address - Street 1:1215 120TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2135
Mailing Address - Country:US
Mailing Address - Phone:425-455-3300
Mailing Address - Fax:425-455-3304
Practice Address - Street 1:1215 120TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2135
Practice Address - Country:US
Practice Address - Phone:425-455-3300
Practice Address - Fax:425-455-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty