Provider Demographics
NPI:1912390113
Name:KULA CHIROPRACTIC SPORTS & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:KULA CHIROPRACTIC SPORTS & WELLNESS CENTER, INC
Other - Org Name:KULA CHIROPRACTIC SPORTS & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KULA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-303-2141
Mailing Address - Street 1:PO BOX 1759
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-1759
Mailing Address - Country:US
Mailing Address - Phone:509-493-4000
Mailing Address - Fax:509-493-4001
Practice Address - Street 1:320 E JEWETT BLVD
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-3002
Practice Address - Country:US
Practice Address - Phone:509-493-4000
Practice Address - Fax:509-493-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60202833111NS0005X
WACH60202314111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty