Provider Demographics
NPI:1639404890
Name:INTERNATIONAL ONE CHIROPRACTIC PS CORP.
Entity Type:Organization
Organization Name:INTERNATIONAL ONE CHIROPRACTIC PS CORP.
Other - Org Name:INTERNATIONAL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:WUK
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-721-7200
Mailing Address - Street 1:6951 MLK JR WAY S STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3545
Mailing Address - Country:US
Mailing Address - Phone:206-721-7200
Mailing Address - Fax:206-339-7200
Practice Address - Street 1:6951 MLK JR WAY S STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3545
Practice Address - Country:US
Practice Address - Phone:206-721-7200
Practice Address - Fax:206-339-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60064547111N00000X
WACH00003391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========Medicaid