Healthcare Provider Details

I. General information

NPI: 1912197203
Provider Name (Legal Business Name): BACKFIRE INC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 14TH AVE E
SEATTLE WA
98112-5223
US

IV. Provider business mailing address

203 14TH AVE E
SEATTLE WA
98112-5223
US

V. Phone/Fax

Practice location:
  • Phone: 206-381-3473
  • Fax: 206-388-0913
Mailing address:
  • Phone: 206-323-2225
  • Fax: 206-388-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberCH00002928
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANH THU HOANG NGUYEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 253-293-2444