Healthcare Provider Details

I. General information

NPI: 1922910256
Provider Name (Legal Business Name): 360 CHIRO & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31919 1ST AVE S STE 100
FEDERAL WAY WA
98003-5258
US

IV. Provider business mailing address

31919 1ST AVE S STE 100
FEDERAL WAY WA
98003-5258
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIE KORNEGAY
Title or Position: DOCTOR
Credential: DC
Phone: 704-340-8476