Healthcare Provider Details

I. General information

NPI: 1902844095
Provider Name (Legal Business Name): SUKJAE JAE HUR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31260 PACIFIC HWY S. STE 9
FEDERALWAY WA
98003-5448
US

IV. Provider business mailing address

31260 PACIFIC HWY S. STE 9
FEDERALWAY WA
98003-5448
US

V. Phone/Fax

Practice location:
  • Phone: 253-528-0172
  • Fax: 253-528-0173
Mailing address:
  • Phone: 253-528-0172
  • Fax: 253-528-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034559
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: