Provider Demographics
NPI:1629522420
Name:MEDISPINE CLINIC
Entity Type:Organization
Organization Name:MEDISPINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKJAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC,FAAIM
Authorized Official - Phone:206-324-6144
Mailing Address - Street 1:2377 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5348
Mailing Address - Country:US
Mailing Address - Phone:206-324-6144
Mailing Address - Fax:206-324-6843
Practice Address - Street 1:2377 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5348
Practice Address - Country:US
Practice Address - Phone:206-324-6144
Practice Address - Fax:206-324-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034559261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center