Provider Demographics
NPI:1447296819
Name:SCR PS
Entity type:Organization
Organization Name:SCR PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-527-0123
Mailing Address - Street 1:1100 NE 47TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4686
Mailing Address - Country:US
Mailing Address - Phone:206-527-0123
Mailing Address - Fax:206-527-0133
Practice Address - Street 1:1100 NE 47TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4686
Practice Address - Country:US
Practice Address - Phone:206-527-0123
Practice Address - Fax:206-527-0133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCR PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU86893Medicare UPIN
WA8809279Medicare PIN