Provider Demographics
NPI:1235227174
Name:TRI HEALTH CLINIC INC
Entity Type:Organization
Organization Name:TRI HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:JOON
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-859-9105
Mailing Address - Street 1:11275 EAST MISSISSIPPI AVENUE
Mailing Address - Street 2:SUITE 2S2
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3263
Mailing Address - Country:US
Mailing Address - Phone:720-859-9105
Mailing Address - Fax:720-859-9106
Practice Address - Street 1:11275 EAST MISSISSIPPI AVENUE
Practice Address - Street 2:SUITE 2S2
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3263
Practice Address - Country:US
Practice Address - Phone:720-859-9105
Practice Address - Fax:720-859-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5193111N00000X
171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO806940Medicare PIN