Provider Demographics
NPI:1477570109
Name:KVATERNIK, JEFFREY JOHN (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:KVATERNIK
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7267 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5534
Mailing Address - Country:US
Mailing Address - Phone:360-438-9609
Mailing Address - Fax:360-456-7380
Practice Address - Street 1:7267 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5534
Practice Address - Country:US
Practice Address - Phone:360-438-9609
Practice Address - Fax:360-456-7380
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025202-CH00002200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2007748Medicaid
WA0190475OtherWORKERS COMPENSATION
WAT02862Medicare UPIN
WA2007748Medicaid