Provider Demographics
NPI:1952612269
Name:SEATTLE BACK CLINIC P.S.INC.
Entity Type:Organization
Organization Name:SEATTLE BACK CLINIC P.S.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-325-1575
Mailing Address - Street 1:2041 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2959
Mailing Address - Country:US
Mailing Address - Phone:206-325-1575
Mailing Address - Fax:106-328-0514
Practice Address - Street 1:2041 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2959
Practice Address - Country:US
Practice Address - Phone:206-325-1575
Practice Address - Fax:206-328-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty