Provider Demographics
NPI:1821216805
Name:SHOTWELL, KENNETH B (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:SHOTWELL
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:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-0501
Mailing Address - Country:US
Mailing Address - Phone:360-435-2222
Mailing Address - Fax:
Practice Address - Street 1:118 E HALLER
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-9131
Practice Address - Country:US
Practice Address - Phone:360-435-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA24616OtherDEPT L&I PROVIDER #
WA24616OtherDEPT L&I PROVIDER #
912015784Medicare UPIN