Provider Demographics
NPI:1700275849
Name:UNISON CHIROPRACTIC PS
Entity Type:Organization
Organization Name:UNISON CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:MO
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:MICHELLE CHUNG
Authorized Official - Phone:253-853-7580
Mailing Address - Street 1:5358 33RD AVE NW STE 204
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1773
Mailing Address - Country:US
Mailing Address - Phone:253-853-7580
Mailing Address - Fax:253-853-7582
Practice Address - Street 1:5358 33RD AVE NW STE 204
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1773
Practice Address - Country:US
Practice Address - Phone:253-853-7580
Practice Address - Fax:253-853-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACH0034489261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVO7829Medicare UPIN