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General NPI Number Information
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NPI Number | 1629522420
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Entity Type | Organization
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Legal Business Name | MEDISPINE CLINIC
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 2377 RAINIER AVE S
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City | SEATTLE
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State | WA
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Zip | 98144-5348
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Country | US
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Telephone | 206-324-6144
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Fax | 206-324-6843
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Provider Business Mailing Address
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Address Line | 2377 RAINIER AVE S
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City | SEATTLE
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State | WA
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Zip | 98144-5348
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Country | US
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Telephone | 206-324-6144
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Fax | 206-324-6843
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SUKJAE HUR
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Credential | DC,FAAIM.
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Telephone | 206-324-6144
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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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