Healthcare Provider Details

I. General information

NPI: 1689798886
Provider Name (Legal Business Name): PAUL A MACK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 NW RICHMOND BEACH RD
SHORELINE WA
98177-3122
US

IV. Provider business mailing address

636 NW RICHMOND BEACH RD
SHORELINE WA
98177-3122
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-7571
  • Fax: 206-546-1795
Mailing address:
  • Phone: 206-542-7571
  • Fax: 206-546-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1883
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: