Healthcare Provider Details

I. General information

NPI: 1386729267
Provider Name (Legal Business Name): JAMES S PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15027 AURORA AVE N
SHORELINE WA
98133-6134
US

IV. Provider business mailing address

15027 AURORA AVE N
SHORELINE WA
98133-6134
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-3520
  • Fax: 206-362-3521
Mailing address:
  • Phone: 206-362-3520
  • Fax: 206-362-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034032
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00023282
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00017069
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00020695
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00022178
License Number StateWA

VIII. Authorized Official

Name: MR. JAMES S PARK
Title or Position: OWNER
Credential: D.C.
Phone: 206-362-3520