Provider Demographics
NPI:1942214291
Name:BACK TO HEALTH CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:TUAN
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-856-8868
Mailing Address - Street 1:20930 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1101
Mailing Address - Country:US
Mailing Address - Phone:253-856-8868
Mailing Address - Fax:253-856-3654
Practice Address - Street 1:20930 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1101
Practice Address - Country:US
Practice Address - Phone:253-856-8868
Practice Address - Fax:253-856-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB22351Medicare ID - Type Unspecified