Provider Demographics
NPI:1669512455
Name:KACZMARSKI, VERNON HOWARD (DC)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:HOWARD
Last Name:KACZMARSKI
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 1:3459 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2176
Mailing Address - Country:US
Mailing Address - Phone:206-241-2225
Mailing Address - Fax:206-241-5562
Practice Address - Street 1:3459 S 152ND ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2176
Practice Address - Country:US
Practice Address - Phone:206-241-2225
Practice Address - Fax:206-241-5562
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKA0067OtherREGENCE
WA50538OtherLABOR & INDUSTRIES
WA2014876Medicaid
WA50538OtherLABOR & INDUSTRIES