Provider Demographics
NPI:1356901839
Name:KHAKH, BALRAJ (DC)
Entity type:Individual
Prefix:
First Name:BALRAJ
Middle Name:
Last Name:KHAKH
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 1:11020 SE KENT KANGLEY RD APT EE102
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7299
Mailing Address - Country:US
Mailing Address - Phone:925-922-2093
Mailing Address - Fax:
Practice Address - Street 1:1426 S 324TH ST STE B115
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8486
Practice Address - Country:US
Practice Address - Phone:253-838-1441
Practice Address - Fax:253-838-4345
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60953772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor