Provider Demographics
NPI:1326311531
Name:KYNCL, JEREMY (LMT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:KYNCL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14222 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2188
Mailing Address - Country:US
Mailing Address - Phone:509-891-1999
Mailing Address - Fax:509-891-8119
Practice Address - Street 1:14222 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2188
Practice Address - Country:US
Practice Address - Phone:509-891-1999
Practice Address - Fax:509-891-8119
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60246652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist