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General NPI Number Information
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NPI Number | 1255440087
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Entity Type | Organization
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Legal Business Name | BLUE STONE CHIROPRACTIC PS
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 620 KIRKLAND WAY SUITE 105
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City | KIRKLAND
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State | WA
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Zip | 98033-6021
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Country | US
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Telephone | 425-822-1859
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Fax | 425-822-2920
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Provider Business Mailing Address
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Address Line | 620 KIRKLAND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98033-6021
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Country | US
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Telephone | 425-822-1859
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Fax | 425-822-2920
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK M TRAVERS
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Credential | DC
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Telephone | 425-822-1859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH34314
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License Number State | WA
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