Provider Demographics
NPI:1376660589
Name:ULMER, KEVIN JAMES (D C)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:ULMER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5202
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-5202
Mailing Address - Country:US
Mailing Address - Phone:253-520-0158
Mailing Address - Fax:253-854-9860
Practice Address - Street 1:10422 PORTLAND AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-5240
Practice Address - Country:US
Practice Address - Phone:253-535-0186
Practice Address - Fax:253-535-8814
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
109410OtherDLI
WAU62209Medicare UPIN
109410OtherDLI