Healthcare Provider Details

I. General information

NPI: 1336642420
Provider Name (Legal Business Name): OTTO FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34730 PACIFIC HWY S
FEDERAL WAY WA
98003-6821
US

IV. Provider business mailing address

34730 PACIFIC HWY S
FEDERAL WAY WA
98003-6821
US

V. Phone/Fax

Practice location:
  • Phone: 253-447-6667
  • Fax: 253-874-0408
Mailing address:
  • Phone: 253-447-6667
  • Fax: 253-874-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NATHANIEL ELI OTTO
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 208-313-9247