Provider Demographics
NPI:1861628901
Name:MUKILTEO CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:MUKILTEO CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KREUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-353-1011
Mailing Address - Street 1:8004 MUKILTEO SPEEDWAY STE 1
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2653
Mailing Address - Country:US
Mailing Address - Phone:425-353-1011
Mailing Address - Fax:425-353-1033
Practice Address - Street 1:8004 MUKILTEO SPEEDWAY STE 1
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2653
Practice Address - Country:US
Practice Address - Phone:425-353-1011
Practice Address - Fax:425-353-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU76529Medicare UPIN