Provider Demographics
NPI:1164864526
Name:CHIN, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 17TH AVE NW
Mailing Address - Street 2:#17178
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98127-1679
Mailing Address - Country:US
Mailing Address - Phone:206-473-7733
Mailing Address - Fax:
Practice Address - Street 1:5706 17TH AVE NW
Practice Address - Street 2:#17178
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98127-1679
Practice Address - Country:US
Practice Address - Phone:206-473-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00025305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist