Provider Demographics
NPI:1346394400
Name:ELY, KENNETH EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EUGENE
Last Name:ELY
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 1:399 H ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4100
Mailing Address - Country:US
Mailing Address - Phone:360-332-4730
Mailing Address - Fax:360-332-3309
Practice Address - Street 1:365 H ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4109
Practice Address - Country:US
Practice Address - Phone:360-332-4730
Practice Address - Fax:360-332-3309
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA360320000OtherBCBS
WA91-1218101OtherFED EMP. ID #
WA2065308OtherDSHS
WA7785313OtherAETNA
WA350019617OtherPALMETTO RAIL MED.
WA34345OtherDEPT. OF LABOR & INDUST.
WA1668403003OtherCIGNA PAL
WA34345OtherDEPT. OF LABOR & INDUST.