Healthcare Provider Details

I. General information

NPI: 1588637151
Provider Name (Legal Business Name): JOHN D HUYNH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 205TH AVE E STE C
BONNEY LAKE WA
98391-8275
US

IV. Provider business mailing address

9812 205TH AVE E STE C
BONNEY LAKE WA
98391-8275
US

V. Phone/Fax

Practice location:
  • Phone: 253-863-6378
  • Fax: 253-863-6429
Mailing address:
  • Phone: 253-863-6378
  • Fax: 253-863-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034563
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: