Provider Demographics
NPI:1649491317
Name:MARK S. JYRINGI, DC, PS
Entity type:Organization
Organization Name:MARK S. JYRINGI, DC, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-547-4427
Mailing Address - Street 1:5029 ROOSEVELT WAY NE
Mailing Address - Street 2:#101A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3600
Mailing Address - Country:US
Mailing Address - Phone:206-547-4427
Mailing Address - Fax:206-547-3587
Practice Address - Street 1:5029 ROOSEVELT WAY NE
Practice Address - Street 2:#101A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3600
Practice Address - Country:US
Practice Address - Phone:206-547-4427
Practice Address - Fax:206-547-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU61570OtherUPIN
WA0060139OtherLABOR & INDUSTRIES
WAJY5775OtherREGENCE BLUE SHIELD
WA0060139OtherLABOR & INDUSTRIES