Provider Demographics
NPI:1255499695
Name:MIDTOWN CHIROPRACTIC & REHABILITATION
Entity Type:Organization
Organization Name:MIDTOWN CHIROPRACTIC & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-682-1424
Mailing Address - Street 1:1420 5TH AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-4087
Mailing Address - Country:US
Mailing Address - Phone:206-682-1424
Mailing Address - Fax:
Practice Address - Street 1:1420 5TH AVE
Practice Address - Street 2:STE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-4087
Practice Address - Country:US
Practice Address - Phone:206-682-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA54005OtherDEPT. OF LABOR AND INDU
WABU9443OtherREGENCE RIDER NUMBER
WA8862511Medicare PIN