Provider Demographics
NPI:1285730556
Name:DANG, MIKE (DC)
Entity type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:DANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KHANH
Other - Middle Name:
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:17821 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6420
Mailing Address - Country:US
Mailing Address - Phone:425-430-5425
Mailing Address - Fax:
Practice Address - Street 1:17821 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6420
Practice Address - Country:US
Practice Address - Phone:425-430-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor