Provider Demographics
NPI:1902187024
Name:BACK AND NECK PAIN CENTER OF LYNNWOOD PLLC
Entity Type:Organization
Organization Name:BACK AND NECK PAIN CENTER OF LYNNWOOD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRIK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-218-6955
Mailing Address - Street 1:16825 48TH AVE W
Mailing Address - Street 2:#110
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-6401
Mailing Address - Country:US
Mailing Address - Phone:206-218-6955
Mailing Address - Fax:425-775-7975
Practice Address - Street 1:16825 48TH AVE W
Practice Address - Street 2:#110
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6401
Practice Address - Country:US
Practice Address - Phone:206-218-6955
Practice Address - Fax:425-775-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty