Provider Demographics
NPI:1689649378
Name:BATES, KEVIN ROBERT (DC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ROBERT
Last Name:BATES
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 1:365 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1527
Mailing Address - Country:US
Mailing Address - Phone:360-805-1555
Mailing Address - Fax:
Practice Address - Street 1:365 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1527
Practice Address - Country:US
Practice Address - Phone:360-805-1555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor