Healthcare Provider Details

I. General information

NPI: 1043317696
Provider Name (Legal Business Name): KENT KARSCHNIK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 19TH AVE E
SEATTLE WA
98112-3505
US

IV. Provider business mailing address

1100 19TH AVE E
SEATTLE WA
98112-3505
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-4395
  • Fax:
Mailing address:
  • Phone: 206-322-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH00003302
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: