Healthcare Provider Details

I. General information

NPI: 1689884819
Provider Name (Legal Business Name): ERIC KLOS D.C, C.C.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 7TH AVE
KIRKLAND WA
98033-5665
US

IV. Provider business mailing address

634 7TH AVE
KIRKLAND WA
98033-5665
US

V. Phone/Fax

Practice location:
  • Phone: 425-822-2858
  • Fax: 425-822-5611
Mailing address:
  • Phone: 425-822-2858
  • Fax: 425-822-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number63098
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: