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General NPI Number Information
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NPI Number | 1063960581
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Entity Type | Organization
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Legal Business Name | MYOMEDI CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 31260 PACIFIC HWY S STE 9
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5448
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Country | US
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Telephone | 253-528-0172
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Fax | 253-528-0173
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Provider Business Mailing Address
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Address Line | 31260 PACIFIC HWY S STE 9
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5448
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Country | US
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Telephone | 253-528-0172
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Fax | 253-528-0173
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SUK JAE HUR
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Credential | DC, FAAIM
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Telephone | 253-528-0172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH00034559
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License Number State | WA
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