Provider Demographics
NPI:1386729267
Name:JAMES S PARK
Entity type:Organization
Organization Name:JAMES S PARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-362-3520
Mailing Address - Street 1:15027 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6134
Mailing Address - Country:US
Mailing Address - Phone:206-362-3520
Mailing Address - Fax:206-362-3521
Practice Address - Street 1:15027 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6134
Practice Address - Country:US
Practice Address - Phone:206-362-3520
Practice Address - Fax:206-362-3521
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES S PARK CENTRAL CHIROPRACTIC CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034032111N00000X
WAMA00020695174400000X
WAMA00022178174400000X
WAMA00023282174400000X
WAMA00017069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB36460Medicare ID - Type Unspecified
WAU88194Medicare UPIN