Provider Demographics
NPI:1942387766
Name:REDMOND SPINE CENTER, PLLC
Entity Type:Organization
Organization Name:REDMOND SPINE CENTER, PLLC
Other - Org Name:INTEGRATED HEALTH CENTER OF WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEON
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-881-3100
Mailing Address - Street 1:15655 NE 85TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3563
Mailing Address - Country:US
Mailing Address - Phone:425-881-3100
Mailing Address - Fax:425-881-3102
Practice Address - Street 1:15655 NE 85TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3563
Practice Address - Country:US
Practice Address - Phone:425-881-3100
Practice Address - Fax:425-881-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3312111N00000X
WACH34573111N00000X
WACH3657111NN0400X
WAAC2569171100000X
WANT1446175F00000X
WANT1443175F00000X
WAMD40676207Q00000X
WAPT8072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858518Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER