Provider Demographics
NPI:1295051316
Name:ACTIVE SPINES INC.
Entity type:Organization
Organization Name:ACTIVE SPINES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAO-HAO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-818-0086
Mailing Address - Street 1:1530 BELLEVUE WAY SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-7110
Mailing Address - Country:US
Mailing Address - Phone:425-818-0086
Mailing Address - Fax:425-818-5224
Practice Address - Street 1:1530 BELLEVUE WAY SE
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-7110
Practice Address - Country:US
Practice Address - Phone:425-818-0086
Practice Address - Fax:425-818-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602977126261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service