Provider Demographics
NPI:1639239841
Name:BABICH, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BABICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10618 SE KENT KANGLEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-9048
Mailing Address - Country:US
Mailing Address - Phone:253-859-5433
Mailing Address - Fax:253-859-4887
Practice Address - Street 1:10618 SE KENT KANGLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-9048
Practice Address - Country:US
Practice Address - Phone:253-859-5433
Practice Address - Fax:253-859-4887
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
104390100OtherOSWC FEDERAL WORKERS COMP
WA126230OtherDEPT OF L&I
WABA7421OtherREGENCE BLUE SHIELD
WABA7421OtherREGENCE BLUE SHIELD
U75711Medicare UPIN