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COAST SPINE AND SPORTS MEDICINE, PLLC

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Company Details

Legal Name: COAST SPINE AND SPORTS MEDICINE, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: June 9th 2020
Expiration date: 30 Jun 2026
UBI Number: 604 625 120
ZIP code: 98373
City: Puyallup
County: PIERCE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 8012 112TH STREET CT E, SUITE 120, PUYALLUP, WA, 98373-7856, UNITED STATES

Contact Details

E-Mail: BCHAN@COASTINJURY.NET
Phone Number: +1 253-648-1853

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
BRIAN CHAN Registered Agent 8012 112TH STREET CT E, SUITE 120, PUYALLUP, WA, 98373-7856, UNITED STATES

Key Officers & Management

Name Role Address
BRIAN CHAN Executor 415 W REPUBLICAN ST UNIT 200, SEATTLE, WA, 98119-4084, UNITED STATES
BRIAN CHAN Governing Person 15930 63RD DR SE, SNOHOMISH, WA, 98296-8793, UNITED STATES
KYLE OSBORNE Governing Person -

National Provider Identifier

NPI Number:
1790593374
Certification Date:
2024-12-27

Authorized Person:

Name:
SANDY CLEMENS
Role:
ACCESS MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
Yes

Contacts:

Fax:
4258009756

Form 5500 Series

Employer Identification Number (EIN):
851356731
Plan Year:
2024
Number Of Participants:
26
Sponsor's telephone number:
Plan Administrator / Signatory:
RACHEL JAGER(Plan administrator)
Plan Year:
2023
Number Of Participants:
13
Sponsor's telephone number:
Plan Administrator / Signatory:
JULIA TAYLOR(Plan administrator)
Plan Year:
2022
Number Of Participants:
6
Sponsor's telephone number:
Plan Administrator / Signatory:
JULIA TAYLOR(Plan administrator)
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