Healthcare Provider Details

I. General information

NPI: 1538208855
Provider Name (Legal Business Name): BRICE PATRICK KOVARIK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20218 77TH AVE NE STE. A
ARLINGTON WA
98223
US

IV. Provider business mailing address

20218 77TH AVE NE STE. A
ARLINGTON WA
98223
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-3900
  • Fax: 360-435-1105
Mailing address:
  • Phone: 360-435-3900
  • Fax: 360-435-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: