Provider Demographics
NPI:1831138064
Name:KELLEY, PHILIP EUGENE (LAC, EAMP)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:EUGENE
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SW 149TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1958
Mailing Address - Country:US
Mailing Address - Phone:206-244-2471
Mailing Address - Fax:206-241-7677
Practice Address - Street 1:630 SW 149TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1958
Practice Address - Country:US
Practice Address - Phone:206-244-2471
Practice Address - Fax:206-241-7677
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist