Provider Demographics
NPI:1902400583
Name:OSMED SPINE CLINIC PS
Entity Type:Organization
Organization Name:OSMED SPINE CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKJAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FAAIM
Authorized Official - Phone:425-999-2104
Mailing Address - Street 1:919 HARRINGTON AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3013
Mailing Address - Country:US
Mailing Address - Phone:425-291-7247
Mailing Address - Fax:425-988-3104
Practice Address - Street 1:919 HARRINGTON AVE NE STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3013
Practice Address - Country:US
Practice Address - Phone:425-291-7247
Practice Address - Fax:425-988-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty