Healthcare Provider Details

I. General information

NPI: 1962091009
Provider Name (Legal Business Name): JUSTIN BYRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33400 13TH PL S
FEDERAL WAY WA
98003-6357
US

IV. Provider business mailing address

33400 13TH PL S
FEDERAL WAY WA
98003-6357
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-6070
  • Fax: 253-838-6069
Mailing address:
  • Phone: 253-838-6070
  • Fax: 253-838-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number61134063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: