Provider Demographics
NPI:1669921821
Name:FRASER, PIYUMIKA SANDAMALI (DC)
Entity type:Individual
Prefix:
First Name:PIYUMIKA
Middle Name:SANDAMALI
Last Name:FRASER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PIYUMIKA
Other - Middle Name:
Other - Last Name:APPUHAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10318 244TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5780
Mailing Address - Country:US
Mailing Address - Phone:206-696-9201
Mailing Address - Fax:
Practice Address - Street 1:10512 NE 68TH ST STE C102
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7002
Practice Address - Country:US
Practice Address - Phone:425-889-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60446943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor