Provider Demographics
NPI:1023044880
Name:BRACK, STEVEN CHAS (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHAS
Last Name:BRACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:805 MADISON ST.
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-838-2590
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:3801 5TH ST SE
Practice Address - Street 2:SUITE 110
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2106
Practice Address - Country:US
Practice Address - Phone:253-845-9585
Practice Address - Fax:253-435-4785
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-10-18
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001216207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E17486Medicare UPIN