Provider Demographics
NPI:1568579944
Name:UNITED BACKCARE PS
Entity type:Organization
Organization Name:UNITED BACKCARE PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPORES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:425-513-8509
Mailing Address - Street 1:9617 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3710
Mailing Address - Country:US
Mailing Address - Phone:425-513-8509
Mailing Address - Fax:425-290-9774
Practice Address - Street 1:9617 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3710
Practice Address - Country:US
Practice Address - Phone:425-513-8509
Practice Address - Fax:425-290-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7021751Medicaid
WAG115149500Medicare PIN