Provider Demographics
NPI:1285398529
Name:PAC HIGHWAY CHIROPRACTIC
Entity type:Organization
Organization Name:PAC HIGHWAY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-923-7600
Mailing Address - Street 1:13030 MILITARY RD S STE 106
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3079
Mailing Address - Country:US
Mailing Address - Phone:206-923-7600
Mailing Address - Fax:206-923-7601
Practice Address - Street 1:13030 MILITARY RD S STE 106
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3079
Practice Address - Country:US
Practice Address - Phone:206-923-7600
Practice Address - Fax:206-923-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty