Healthcare Provider Details

I. General information

NPI: 1770219420
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF KENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SE 208TH ST STE 207
KENT WA
98031-5545
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1266
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-3185
  • Fax: 253-852-9210
Mailing address:
  • Phone: 630-229-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SYLVIA KIM
Title or Position: DC
Credential:
Phone: 847-971-2447