Healthcare Provider Details

I. General information

NPI: 1962459321
Provider Name (Legal Business Name): JOHN PATRICK KELLOGG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 PACIFIC AVE
TACOMA WA
98408-7036
US

IV. Provider business mailing address

7817 PACIFIC AVE
TACOMA WA
98408-7036
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-6061
  • Fax: 253-472-6195
Mailing address:
  • Phone: 253-472-6061
  • Fax: 253-472-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH00034147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: