Provider Demographics
NPI:1821352675
Name:WASHINGTON CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:WASHINGTON CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-251-3101
Mailing Address - Street 1:7100 FUN CENTER WAY
Mailing Address - Street 2:#120
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5540
Mailing Address - Country:US
Mailing Address - Phone:425-251-3101
Mailing Address - Fax:425-228-6566
Practice Address - Street 1:7100 FUN CENTER WAY
Practice Address - Street 2:#120
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5540
Practice Address - Country:US
Practice Address - Phone:425-251-3101
Practice Address - Fax:425-228-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU65310Medicare UPIN