Provider Demographics
NPI:1033414552
Name:TUKWILA COMMUNITY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TUKWILA COMMUNITY CHIROPRACTIC PLLC
Other - Org Name:DR. MARK HUCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DR CHIROPRACTOR
Authorized Official - Phone:425-251-3101
Mailing Address - Street 1:7100 FUN CENTER WAY
Mailing Address - Street 2:#120
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188
Mailing Address - Country:US
Mailing Address - Phone:425-251-3101
Mailing Address - Fax:206-582-2976
Practice Address - Street 1:7100 FUN CENTER WAY
Practice Address - Street 2:#120
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:425-251-3101
Practice Address - Fax:206-582-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003356111N00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA132063OtherLABOR AND INDUSTRIES
WAHU5492OtherBLUE CROSS
WA132063OtherLABOR AND INDUSTRIES