Provider Demographics
NPI:1235336025
Name:KINGSTON CROSSING WELLNESS PS
Entity Type:Organization
Organization Name:KINGSTON CROSSING WELLNESS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHIBJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-297-0037
Mailing Address - Street 1:8202 NE STATE HIGHWAY 104
Mailing Address - Street 2:SUTIE 105
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9454
Mailing Address - Country:US
Mailing Address - Phone:360-297-0037
Mailing Address - Fax:360-297-0420
Practice Address - Street 1:8202 NE STATE HIGHWAY 104 STE 105
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9454
Practice Address - Country:US
Practice Address - Phone:360-297-0037
Practice Address - Fax:360-297-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
WA6605160001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602719982Medicare UPIN
WA6605160001Medicare NSC