Provider Demographics
NPI:1245383389
Name:KITAEFF, RICHARD JACK (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JACK
Last Name:KITAEFF
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:23700 EDMONDS WAY
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8978
Mailing Address - Country:US
Mailing Address - Phone:425-775-6001
Mailing Address - Fax:425-776-7119
Practice Address - Street 1:23700 EDMONDS WAY
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8978
Practice Address - Country:US
Practice Address - Phone:425-775-6001
Practice Address - Fax:425-776-7119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000007171100000X
WANT00000507175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath