MEDICARE: KENDALL SWEENEY DC

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	111N00000X	Chiropractor	CH60756796	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770009755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL SWEENEY DC

Provider Business Mailing Address
First Line	:	13128 TOTEM LAKE BLVD NE STE 203
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-2953
Country	:	US
Telephone Number	:	425-820-8837
Fax Number	:	425-820-7009

Provider Business Practice Location Address
First Line	:	3395 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-9810
Country	:	US
Telephone Number	:	206-660-6968
Fax Number	:

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

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	01/04/2019

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Directions to “ KENDALL SWEENEY DC” Practice Location

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