Provider Demographics
NPI:1740541911
Name:UNISON CHIROPRACTIC, PS
Entity type:Organization
Organization Name:UNISON CHIROPRACTIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:MO
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-853-7580
Mailing Address - Street 1:5358 33RD AVE. NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-853-7580
Mailing Address - Fax:253-853-7582
Practice Address - Street 1:5358 33RD AVE. NW
Practice Address - Street 2:SUITE 204
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
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:2012-06-05
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034489111N00000X
111N00000X
CACH00334489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8857815Medicare PIN
WAG58857815Medicare PIN