Provider Demographics
NPI:1164750196
Name:CHILD, KEVEN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVEN
Middle Name:MICHAEL
Last Name:CHILD
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 1:14773 ROAD 3 SW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-9585
Mailing Address - Country:US
Mailing Address - Phone:509-438-3417
Mailing Address - Fax:
Practice Address - Street 1:21 D ST SW # C4
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1236
Practice Address - Country:US
Practice Address - Phone:509-906-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60127376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor