Provider Demographics
NPI:1427393990
Name:KM STAMWITZ PLLC
Entity Type:Organization
Organization Name:KM STAMWITZ PLLC
Other - Org Name:RANDALL CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STAMWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-459-1320
Mailing Address - Street 1:1320 COLLEGE ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2366
Mailing Address - Country:US
Mailing Address - Phone:360-459-1320
Mailing Address - Fax:360-923-1940
Practice Address - Street 1:1320 COLLEGE ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2366
Practice Address - Country:US
Practice Address - Phone:360-459-1320
Practice Address - Fax:360-923-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty