Healthcare Provider Details

I. General information

NPI: 1033414552
Provider Name (Legal Business Name): TUKWILA COMMUNITY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 FUN CENTER WAY #120
TUKWILA WA
98188
US

IV. Provider business mailing address

7100 FUN CENTER WAY #120
TUKWILA WA
98188
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-3101
  • Fax: 206-582-2976
Mailing address:
  • Phone: 425-251-3101
  • Fax: 206-582-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003356
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCH00003356
License Number StateWA

VIII. Authorized Official

Name: DR. MARK THOMAS HUCK
Title or Position: CHIROPRACTOR
Credential: DR. CHIROPRACTOR
Phone: 425-251-3101