Provider Demographics
NPI:1588706899
Name:FEDERLE, JANE MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:MITCHELL
Last Name:FEDERLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 NE 65TH ST # 225
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6655
Mailing Address - Country:US
Mailing Address - Phone:206-866-8711
Mailing Address - Fax:
Practice Address - Street 1:7522 20TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4402
Practice Address - Country:US
Practice Address - Phone:206-866-8711
Practice Address - Fax:206-866-8711
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60550533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60550533OtherWASHINGTON CHIROPRACTIC LICENSE