Provider Demographics
NPI:1689798886
Name:MACK, PAUL A (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:MACK
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 1:636 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3122
Mailing Address - Country:US
Mailing Address - Phone:206-542-7571
Mailing Address - Fax:206-546-1795
Practice Address - Street 1:636 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3122
Practice Address - Country:US
Practice Address - Phone:206-542-7571
Practice Address - Fax:206-546-1795
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1883111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8806625Medicare PIN
WAT01705Medicare UPIN