Provider Demographics
NPI:1679905566
Name:HOUK CHIROPRACTIC-COEUR D'ALENE P.C.
Entity Type:Organization
Organization Name:HOUK CHIROPRACTIC-COEUR D'ALENE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WM
Authorized Official - Last Name:HOUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-664-9134
Mailing Address - Street 1:PO BOX 28503
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-8503
Mailing Address - Country:US
Mailing Address - Phone:509-466-1367
Mailing Address - Fax:509-465-4929
Practice Address - Street 1:610 W HUBBARD ST
Practice Address - Street 2:SUITE 116
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2285
Practice Address - Country:US
Practice Address - Phone:208-664-9134
Practice Address - Fax:208-661-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60299851225700000X
WAMAS-1390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTIN