Provider Demographics
NPI:1881889632
Name:OH FAMILY CHIROPRACTIC CENTER, PS
Entity type:Organization
Organization Name:OH FAMILY CHIROPRACTIC CENTER, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANGIK
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-946-4648
Mailing Address - Street 1:1520 S DASH POINT RD STE B
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3753
Mailing Address - Country:US
Mailing Address - Phone:253-946-4648
Mailing Address - Fax:253-946-4649
Practice Address - Street 1:1520 S DASH POINT RD STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-3753
Practice Address - Country:US
Practice Address - Phone:253-946-4648
Practice Address - Fax:253-946-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8868005Medicare PIN