Healthcare Provider Details

I. General information

NPI: 1568037364
Provider Name (Legal Business Name): KENT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24612 104TH AVE SE
KENT WA
98030-4965
US

IV. Provider business mailing address

PO BOX 5669
KENT WA
98064-5669
US

V. Phone/Fax

Practice location:
  • Phone: 253-520-2529
  • Fax: 253-852-4453
Mailing address:
  • Phone: 253-520-2529
  • Fax: 253-852-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: NADIM HALABI
Title or Position: OWNER
Credential: DC
Phone: 253-520-2529