Healthcare Provider Details

I. General information

NPI: 1225488554
Provider Name (Legal Business Name): ONE SOURCE BURIEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15217 1ST AVE S
BURIEN WA
98148-1009
US

IV. Provider business mailing address

15217 1ST AVE S
BURIEN WA
98148-1009
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-8805
  • Fax:
Mailing address:
  • Phone: 206-244-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. KYLE OSBORNE
Title or Position: OWNER
Credential: D.C.
Phone: 425-773-9586