Healthcare Provider Details

I. General information

NPI: 1558022889
Provider Name (Legal Business Name): KAELYN VOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 213TH ST E
GRAHAM WA
98338-8059
US

IV. Provider business mailing address

PO BOX 988
GRAHAM WA
98338-0988
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-2687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61255415
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH61255415
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH61255415
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberCH61255415
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH61255415
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH61255415
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH61255415
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: