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General NPI Number Information
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NPI Number | 1295051316
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Entity Type | Organization
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Legal Business Name | ACTIVE SPINES INC.
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 1530 BELLEVUE WAY SE SUITE C
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City | BELLEVUE
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State | WA
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Zip | 98004-7110
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Country | US
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Telephone | 425-818-0086
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Fax | 425-818-5224
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Provider Business Mailing Address
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Address Line | 1530 BELLEVUE WAY SE SUITE C
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City | BELLEVUE
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State | WA
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Zip | 98004-7110
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Country | US
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Telephone | 425-818-0086
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Fax | 425-818-5224
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Authorized Official
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Title or Position | OWNER
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Name | SHAO-HAO CHENG
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Credential | D.C.
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Telephone | 425-818-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 602977126
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License Number State | WA
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