Provider Demographics
NPI:1629137468
Name:MCCRACKEN, DANA RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:RYAN
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 CENTRAL WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6104
Mailing Address - Country:US
Mailing Address - Phone:425-605-8508
Mailing Address - Fax:425-605-1288
Practice Address - Street 1:284 CENTRAL WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6104
Practice Address - Country:US
Practice Address - Phone:425-605-8508
Practice Address - Fax:425-605-1288
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB02625OtherGROUP PIN
WA0214522OtherL & I PROVIDER ACCOUNT #
WA0214522OtherL & I PROVIDER ACCOUNT #
WAAB02625OtherGROUP PIN