Provider Demographics
NPI:1467549949
Name:KRISS, PHILLIP J (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:KRISS
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 1:27203 216TH AVENUE SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5510
Mailing Address - Country:US
Mailing Address - Phone:425-432-4621
Mailing Address - Fax:425-432-6495
Practice Address - Street 1:27203 216TH AVE SE
Practice Address - Street 2:SUITE 1
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:425-432-4621
Practice Address - Fax:425-432-6495
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0062692OtherLABOR AND INDUSTRY
WA0062692OtherLABOR AND INDUSTRY