Provider Demographics
NPI:1780768036
Name:BURICK, MARK A (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BURICK
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 1:1904 3RD AVE
Mailing Address - Street 2:STE 252
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1194
Mailing Address - Country:US
Mailing Address - Phone:206-682-1424
Mailing Address - Fax:206-682-9492
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:STE 252
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1194
Practice Address - Country:US
Practice Address - Phone:206-682-1424
Practice Address - Fax:206-682-9492
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABU9443OtherREGENCE BLUE SHIELD RIDER
WAU38399Medicare UPIN