Provider Demographics
NPI:1477862506
Name:DANA CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:DANA CHIROPRACTIC CLINIC, INC
Other - Org Name:CORNERSTONE INTEGRATIVE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MYUNG
Authorized Official - Middle Name:SUK
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC, EAMP
Authorized Official - Phone:206-629-8011
Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-629-8011
Mailing Address - Fax:
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-629-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034519111N00000X
CA29810111N00000X
WAAC60127707171100000X
CA11401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty