Provider Demographics
NPI:1649467101
Name:STUCK, BRIAN MARTIN (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARTIN
Last Name:STUCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 ROOSEVELT WAY NE STE 101A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3697
Mailing Address - Country:US
Mailing Address - Phone:206-547-4427
Mailing Address - Fax:206-547-3587
Practice Address - Street 1:17651 1ST AVE S
Practice Address - Street 2:STE 101
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2715
Practice Address - Country:US
Practice Address - Phone:206-241-3836
Practice Address - Fax:206-241-3967
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor