Provider Demographics
NPI:1376276014
Name:SOUND SPORT AND SPINE
Entity Type:Organization
Organization Name:SOUND SPORT AND SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-386-1144
Mailing Address - Street 1:3119 CHIVE PL SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2321
Mailing Address - Country:US
Mailing Address - Phone:360-386-1144
Mailing Address - Fax:360-300-2700
Practice Address - Street 1:1730 SE MILE HILL DR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3512
Practice Address - Country:US
Practice Address - Phone:360-386-1144
Practice Address - Fax:360-300-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1033657010OtherINDIVIDUAL NPI