Healthcare Provider Details

I. General information

NPI: 1275816613
Provider Name (Legal Business Name): WASHINGTON CHIROPRACTIC ASSOCIATES PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
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 SUITE 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 TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCH60186820
License Number StateWA

VIII. Authorized Official

Name: DR. PHILIP FRANKLIN KOGLER
Title or Position: OWNER
Credential: D.C.
Phone: 360-805-1555