Provider Demographics
NPI:1063960581
Name:MYOMEDI CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:MYOMEDI CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUK JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FAAIM
Authorized Official - Phone:253-528-0172
Mailing Address - Street 1:31260 PACIFIC HWY S STE 9
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5448
Mailing Address - Country:US
Mailing Address - Phone:253-528-0172
Mailing Address - Fax:253-528-0173
Practice Address - Street 1:31260 PACIFIC HWY S STE 9
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5448
Practice Address - Country:US
Practice Address - Phone:253-528-0172
Practice Address - Fax:253-528-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034559261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center