Provider Demographics
NPI:1366581944
Name:LEW C ESTABROOK DC
Entity type:Organization
Organization Name:LEW C ESTABROOK DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESTABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-814-2800
Mailing Address - Street 1:11821 NE 128TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7210
Mailing Address - Country:US
Mailing Address - Phone:425-814-2800
Mailing Address - Fax:425-823-0882
Practice Address - Street 1:11821 NE 128TH ST STE B
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:425-814-2800
Practice Address - Fax:425-823-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0118558OtherL&I GROUP NUMBER
WA2004943Medicaid
WAAB09917Medicare ID - Type UnspecifiedGROUP NUMBER