Provider Demographics
NPI:1871903062
Name:WESTERN WASHINGTON WELLNESS LLC
Entity type:Organization
Organization Name:WESTERN WASHINGTON WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-275-4870
Mailing Address - Street 1:7605 SE 27TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7605 SE 27TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2835
Practice Address - Country:US
Practice Address - Phone:206-275-4870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty