Provider Demographics
NPI:1689884819
Name:KLOS, ERIC (DC, CCN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KLOS
Suffix:
Gender:M
Credentials:DC, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5665
Mailing Address - Country:US
Mailing Address - Phone:425-822-2858
Mailing Address - Fax:425-822-5611
Practice Address - Street 1:634 7TH AVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5665
Practice Address - Country:US
Practice Address - Phone:425-822-2858
Practice Address - Fax:425-822-5611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA63098111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA63098OtherL&I #
WA2542OtherLICENSE NUMBER
WA2542OtherLICENSE NUMBER