Healthcare Provider Details

I. General information

NPI: 1669952800
Provider Name (Legal Business Name): KIN HEALTH & WELLNESS, SPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MAPLE AVE
SNOHOMISH WA
98290-2526
US

IV. Provider business mailing address

16204 ROOSEVELT RD
SNOHOMISH WA
98290-8810
US

V. Phone/Fax

Practice location:
  • Phone: 603-568-3319
  • Fax: 360-568-5106
Mailing address:
  • Phone: 360-635-0858
  • Fax: 360-568-5106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOP60560271
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOP60560271
License Number StateWA

VIII. Authorized Official

Name: DR. ELIZABETH BARRERA
Title or Position: PRESIDENT
Credential: DO
Phone: 360-563-0858