Healthcare Provider Details

I. General information

NPI: 1346738408
Provider Name (Legal Business Name): GONSTEAD CHIROPRACTIC OF SEATTLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13028 INTERURBAN AVE S STE 106
TUKWILA WA
98168-3340
US

IV. Provider business mailing address

13028 INTERURBAN AVE S STE 106
TUKWILA WA
98168-3340
US

V. Phone/Fax

Practice location:
  • Phone: 206-957-7950
  • Fax: 206-957-7952
Mailing address:
  • Phone: 206-957-7950
  • Fax: 206-957-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60036391
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60502337
License Number StateWA

VIII. Authorized Official

Name: DR. KENDRA L BUCHHOLZ
Title or Position: PRESIDENT
Credential: DC
Phone: 206-957-7950