Provider Demographics
NPI:1497028492
Name:SUN AND MOON INC.
Entity Type:Organization
Organization Name:SUN AND MOON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ESCHBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-942-2414
Mailing Address - Street 1:P.O. BOX 89
Mailing Address - Street 2:326 EAST COMMERCIAL ST.
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-2416
Mailing Address - Country:US
Mailing Address - Phone:360-942-2414
Mailing Address - Fax:360-942-2288
Practice Address - Street 1:326 EAST COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-2416
Practice Address - Country:US
Practice Address - Phone:360-942-2414
Practice Address - Fax:360-942-2288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN AND MOON INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-22
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02617Medicare UPIN
WAGAB05887Medicare PIN