Provider Demographics
NPI:1326237330
Name:NON-SURGICAL SPINE CARE CENTER
Entity Type:Organization
Organization Name:NON-SURGICAL SPINE CARE CENTER
Other - Org Name:NON-SURGICAL SPINE CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:KYUNG
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-393-4365
Mailing Address - Street 1:1240 116TH AVE NE # 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3815
Mailing Address - Country:US
Mailing Address - Phone:425-455-3472
Mailing Address - Fax:
Practice Address - Street 1:1240 116TH AVE NE # 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3815
Practice Address - Country:US
Practice Address - Phone:425-455-3472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty