Provider Demographics
NPI:1295941458
Name:MATT BROWN-RUEGG DC PS
Entity type:Organization
Organization Name:MATT BROWN-RUEGG DC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-RUEGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-624-3590
Mailing Address - Street 1:1421 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2021
Mailing Address - Country:US
Mailing Address - Phone:206-624-3590
Mailing Address - Fax:206-583-4139
Practice Address - Street 1:1421 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2021
Practice Address - Country:US
Practice Address - Phone:206-624-3590
Practice Address - Fax:206-583-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151865OtherL & I NUMBER
AB34999Medicare PIN
WA0151865OtherL & I NUMBER
WAU84539Medicare UPIN