Provider Demographics
NPI:1528204690
Name:CHAN HEALTHCARE GROUP PS
Entity Type:Organization
Organization Name:CHAN HEALTHCARE GROUP PS
Other - Org Name:BACK AND NECK PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-233-0818
Mailing Address - Street 1:PO BOX 14136
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-0136
Mailing Address - Country:US
Mailing Address - Phone:206-233-0818
Mailing Address - Fax:206-292-9340
Practice Address - Street 1:900 S JACKSON ST STE 117
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3056
Practice Address - Country:US
Practice Address - Phone:206-233-0818
Practice Address - Fax:206-292-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602884789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty