Provider Demographics
NPI:1538516547
Name:KENT STATION WELLNESS LLC
Entity Type:Organization
Organization Name:KENT STATION WELLNESS LLC
Other - Org Name:KENT STATION CHIROPRACTIC & MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-859-0100
Mailing Address - Street 1:417 RAMSAY WAY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4502
Mailing Address - Country:US
Mailing Address - Phone:253-859-0100
Mailing Address - Fax:253-373-9600
Practice Address - Street 1:417 RAMSAY WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4502
Practice Address - Country:US
Practice Address - Phone:253-859-0100
Practice Address - Fax:253-373-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH34445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty