Provider Demographics
NPI:1689815045
Name:KRISS CHIROPRACTIC PS
Entity Type:Organization
Organization Name:KRISS CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-432-4621
Mailing Address - Street 1:27203 216TH AVENUE SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:425-432-4621
Mailing Address - Fax:425-432-6495
Practice Address - Street 1:27203 216TH AVENUE SE
Practice Address - Street 2:SUITE 1
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-432-4621
Practice Address - Fax:425-432-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KR0084OtherBCBS
KR0084OtherBCBS