Healthcare Provider Details

I. General information

NPI: 1144145376
Provider Name (Legal Business Name): PUYALLUP SPINE AND INJURY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 S MERIDIAN STE A
PUYALLUP WA
98371-6902
US

IV. Provider business mailing address

4437 185TH AVE E
LAKE TAPPS WA
98391-9112
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-4425
  • Fax: 253-445-5712
Mailing address:
  • Phone: 253-841-4425
  • Fax: 253-445-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PHILLIP KRISS
Title or Position: DC
Credential:
Phone: 253-841-4425