Provider Demographics
NPI:1962459321
Name:KELLOGG, JOHN PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:KELLOGG
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 1:7817 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7036
Mailing Address - Country:US
Mailing Address - Phone:253-472-6061
Mailing Address - Fax:253-472-6195
Practice Address - Street 1:7817 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7036
Practice Address - Country:US
Practice Address - Phone:253-472-6061
Practice Address - Fax:253-472-6195
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034147111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB 32811Medicare ID - Type UnspecifiedCHIROPRACTIC