MEDICARE: DR. VYACHESLAV A BORISENKO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	CH00033992	WA

General Provider Information

NPI Number	:	1689744500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VYACHESLAV A BORISENKO D.C.

Provider Business Mailing Address
First Line	:	10024 SE 240TH ST STE 119
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-5124
Country	:	US
Telephone Number	:	253-520-7531
Fax Number	:	253-520-6589

Provider Business Practice Location Address
First Line	:	10024 SE 240TH ST STE 119
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-5124
Country	:	US
Telephone Number	:	253-520-7531
Fax Number	:	253-520-6589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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