Justin John Favreau, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00034786 Issued in WA

Practice address

1225 Dexter Ave North
Seattle, WA 98109

Phone

(206) 497-4962

Fax

(206) 316-8655

NPI assigned

Oct 29, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vital Roots Prof Corp

  • Primary Care Clinic/Center
  • Seattle, WA
  • NPI 1366880767
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1023194339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 DEXTER AVE NORTH",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98109",
            "telephone_number": "206-497-4962",
            "fax_number": "206-316-8655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 DEXTER AVE NORTH",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98109",
            "telephone_number": "206-497-4962",
            "fax_number": "206-316-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAVREAU",
        "first_name": "JUSTIN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-29",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034786",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "6129",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN MEDICARE PTAN",
            "identifier": "8870884",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stella Cha Fausto, MSW, LICSW
• Jennifer Lynn Favell, PH.D.
• Katyjo Favia, PT
• Logan Favia, ED.S.
• Jennifer Favinger, MD
• Elisabeth Ann Faw, RDN
• Vanessa Jane Fawcett, MD, MPH
• Emily Elizabeth Fay, M.D.
• Rachel A Fay, MS, LMFT
• Lucas Fayez Bazi, M.D.

• Chiropractor in Seattle, WA
• Providers in Seattle, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.