1104264811 NPI number — HOUK CHIROPRACTIC-COEUR D'ALENE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104264811 NPI number — HOUK CHIROPRACTIC-COEUR D'ALENE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUK CHIROPRACTIC-COEUR D'ALENE P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104264811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99228-8503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-466-1367
Provider Business Mailing Address Fax Number:
509-465-4929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 W HUBBARD ST
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-664-9134
Provider Business Practice Location Address Fax Number:
208-666-1623
Provider Enumeration Date:
06/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HOUK
Authorized Official First Name:
MARK
Authorized Official Middle Name:
WM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-664-9134

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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