Provider Demographics
NPI:1639163132
Name:O'NEILL, KURT HOWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:HOWARD
Last Name:O'NEILL
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 1:1260 116TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-957-0761
Mailing Address - Fax:425-957-0761
Practice Address - Street 1:1260 116TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-957-0761
Practice Address - Fax:425-957-1156
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0200283OtherL&I NUMBER
WAAB11476Medicare ID - Type UnspecifiedMEDICARE NUMBER