Provider Demographics
NPI:1558115188
Name:KIRKWOOD SPINE PLLC
Entity Type:Organization
Organization Name:KIRKWOOD SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-908-9545
Mailing Address - Street 1:6711 126TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-8652
Mailing Address - Country:US
Mailing Address - Phone:425-908-9545
Mailing Address - Fax:
Practice Address - Street 1:15217 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1009
Practice Address - Country:US
Practice Address - Phone:206-244-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty