Provider Demographics
NPI:1093147191
Name:BLUE SPRING CHIROPRACTC
Entity Type:Organization
Organization Name:BLUE SPRING CHIROPRACTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-588-8340
Mailing Address - Street 1:9701 S TACOMA WAY
Mailing Address - Street 2:106
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4490
Mailing Address - Country:US
Mailing Address - Phone:253-588-8340
Mailing Address - Fax:253-588-8341
Practice Address - Street 1:9701 S TACOMA WAY
Practice Address - Street 2:106
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4490
Practice Address - Country:US
Practice Address - Phone:253-588-8340
Practice Address - Fax:253-588-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty