Provider Demographics
NPI:1295792653
Name:JEX, KEVIN S (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:JEX
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 1:533 S 336TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6329
Mailing Address - Country:US
Mailing Address - Phone:253-838-1080
Mailing Address - Fax:253-838-2551
Practice Address - Street 1:533 S 336TH ST STE A
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6329
Practice Address - Country:US
Practice Address - Phone:253-838-1080
Practice Address - Fax:253-838-2551
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201096OtherL&I
WA2012375Medicaid
WA2012375Medicaid