Provider Demographics
NPI:1699163709
Name:MOBILE CHIROPRACTIC & MASSAGE, PLLC
Entity type:Organization
Organization Name:MOBILE CHIROPRACTIC & MASSAGE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STATEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEDSKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:423-284-1441
Mailing Address - Street 1:15600 NE 8TH ST
Mailing Address - Street 2:B1-468
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3927
Mailing Address - Country:US
Mailing Address - Phone:423-284-1441
Mailing Address - Fax:
Practice Address - Street 1:11111 NE 8TH ST
Practice Address - Street 2:SUITE 20
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4475
Practice Address - Country:US
Practice Address - Phone:423-284-1441
Practice Address - Fax:423-265-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2796261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU38680Medicare UPIN
WA3670064Medicare PIN