1437276441 NPI number — IRENE G LUC PT,DPT,OCS,NPS

Table of content: DR. SCOTT DAVID UNGEMACH D.C. (NPI 1073532131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437276441 NPI number — IRENE G LUC PT,DPT,OCS,NPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUC
Provider First Name:
IRENE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT,DPT,OCS,NPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHOU
Provider Other First Name:
IRENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437276441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 N COLORADO ST
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-7825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-396-3707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 N COLORADO ST
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-396-3707
Provider Business Practice Location Address Fax Number:
509-396-3710
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  60848501 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 2002007688 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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