Provider Demographics
NPI:1902353188
Name:MACK, GREGORY ATTICUS (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ATTICUS
Last Name:MACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3122
Mailing Address - Country:US
Mailing Address - Phone:206-542-7571
Mailing Address - Fax:206-546-1795
Practice Address - Street 1:636 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3122
Practice Address - Country:US
Practice Address - Phone:206-542-7571
Practice Address - Fax:206-546-1795
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60677546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor