Provider Demographics
NPI:1245258854
Name:MANCHESTER, KEVIN WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:MANCHESTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15858 1ST AVENUE SOUTH
Mailing Address - Street 2:SUITE #A104
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148
Mailing Address - Country:US
Mailing Address - Phone:206-838-0022
Mailing Address - Fax:206-838-0021
Practice Address - Street 1:17651 1ST AVE S
Practice Address - Street 2:#101
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2715
Practice Address - Country:US
Practice Address - Phone:206-241-3826
Practice Address - Fax:206-241-3967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WACH00034389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0198117Medicare ID - Type Unspecified