Provider Demographics
NPI:1023002482
Name:MORELAND, KEVIN KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KENNETH
Last Name:MORELAND
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 1:4719 UNIVERSITY WAY NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4400
Mailing Address - Country:US
Mailing Address - Phone:206-322-9355
Mailing Address - Fax:
Practice Address - Street 1:4719 UNIVERSITY WAY NE
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4400
Practice Address - Country:US
Practice Address - Phone:206-322-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2018687Medicaid
WA37719OtherLABOR & INDUSTRIES
T01735Medicare UPIN
WA2018687Medicaid