Dr Justin J Favreau PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00034786 Issued in WA

Legal business name

DR JUSTIN J FAVREAU PLLC

Practice address

1225 Dexter Ave N
Seattle, WA 98109-3518

Phone

(206) 497-4962

Fax

(206) 316-8655

NPI assigned

Oct 25, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Justin John Favreau, D.C.

Title

President/Clinic Director

Phone

(206) 497-4962

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Stability Spine & Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rachel Marie Giordano, ND

  • Naturopath
  • Seattle, WA
  • NPI 1528386620
  NPD
• Mark Thoreau Olin, DC

  • Rehabilitation Chiropractor
  • Seattle, WA
  • NPI 1780367417
  NPD
• Clay J Brannen, LMP

  • Massage Therapist
  • Seattle, WA
  • NPI 1902236086
  NPD (past)
• Dionna Couch

  • Specialist
  • Seattle, WA
  • NPI 1538589445
  NPD (past)

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369785600000",
    "number": "1386920171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 DEXTER AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981093518",
            "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 N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981093518",
            "telephone_number": "206-497-4962",
            "fax_number": "206-316-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JUSTIN J FAVREAU PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2013-05-29",
        "status": "A",
        "authorized_official_last_name": "FAVREAU",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "206-497-4962",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES - INDIVIDUAL",
            "identifier": "0261812",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1023194339",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "8870884",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES - GROUP",
            "identifier": "0268936",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stability Spine & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.