Healthcare Provider Details

I. General information

NPI: 1083732697
Provider Name (Legal Business Name): MARTIN RUSSELL HEHN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S WASHINGTON AVE
KENT WA
98032
US

IV. Provider business mailing address

319 S WASHINGTON AVE
KENT WA
98032
US

V. Phone/Fax

Practice location:
  • Phone: 253-850-9780
  • Fax: 253-850-6445
Mailing address:
  • Phone: 253-850-9780
  • Fax: 253-850-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH2965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: