Basic Information
| Provider Information | |||||||||
| NPI: | 1538645288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FUNCTIONAL HEALTH CONSULTING, LLC | ||||||||
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| OtherOrganizationName: | VIDA INTEGRATED HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 SW EVERETT MALL WAY STE G | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982042715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253555222 | ||||||||
| FaxNumber: | 4253555231 | ||||||||
| Practice Location | |||||||||
| Address1: | 4915 25TH AVE NE STE 104 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981058667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063157998 | ||||||||
| FaxNumber: | 2063162308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2018 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | TROXLER | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4253555222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FUNCTIONAL HEALTH CONSULTING, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician |
No ID Information.