Healthcare Provider Details

I. General information

NPI: 1316006349
Provider Name (Legal Business Name): STEPHEN JAMES ZOGRAFOS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24909 104TH AVE SE SUITE 103
KENT WA
98030-2819
US

IV. Provider business mailing address

13911 SE 242ND PL
KENT WA
98042-5139
US

V. Phone/Fax

Practice location:
  • Phone: 253-850-8163
  • Fax: 253-850-8164
Mailing address:
  • Phone: 253-639-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: