MEDICARE: MIDTOWN CHIROPRACTIC & REHABILITATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54005	OTHER	WA	DEPT. OF LABOR AND INDU
2	BU9443	OTHER	WA	REGENCE RIDER NUMBER

General Provider Information

NPI Number	:	1255499695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN CHIROPRACTIC & REHABILITATION

Provider Business Mailing Address
First Line	:	1420 5TH AVE
Second Line	:	STE 205
City	:	SEATTLE
State	:	WA
Zip	:	98101-4087
Country	:	US
Telephone Number	:	206-682-1424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 5TH AVE
Second Line	:	STE 205
City	:	SEATTLE
State	:	WA
Zip	:	98101-4087
Country	:	US
Telephone Number	:	206-682-1424
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK A BURICK
Credential	:	D.C.
Telephone Number	:	206-682-1424

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	06/25/2013

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Directions to “MIDTOWN CHIROPRACTIC & REHABILITATION ” Practice Location

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