Provider Demographics
NPI:1912051145
Name:HUCK, MARK THOMAS (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:HUCK
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 FUN CENTER WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5540
Mailing Address - Country:US
Mailing Address - Phone:425-251-3101
Mailing Address - Fax:425-228-6566
Practice Address - Street 1:7100 FUN CENTER WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5540
Practice Address - Country:US
Practice Address - Phone:425-251-3101
Practice Address - Fax:425-228-6566
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003356111N00000X
MT813CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA132063OtherL & I
U65310Medicare UPIN
AB17871Medicare ID - Type Unspecified