Provider Demographics
NPI:1013050152
Name:EARLE, KEVIN MICHAEL (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:EARLE
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13613 MERIDIAN E STE 260
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9800
Mailing Address - Country:US
Mailing Address - Phone:253-445-0440
Mailing Address - Fax:253-445-0444
Practice Address - Street 1:10202 149TH ST E
Practice Address - Street 2:SUITE 101B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-3746
Practice Address - Country:US
Practice Address - Phone:253-445-0440
Practice Address - Fax:253-445-0444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB34344Medicare ID - Type Unspecified