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General NPI Number Information
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NPI Number | 1477570109
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Entity Type | Individual
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Provider Name | JEFFREY JOHN KVATERNIK DC, CCSP
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 7267 MARTIN WAY E
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City | OLYMPIA
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State | WA
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Zip | 98516-5534
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Country | US
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Telephone | 360-438-9609
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Fax | 360-456-7380
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Provider Business Mailing Address
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Address Line | 7267 MARTIN WAY E
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City | OLYMPIA
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State | WA
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Zip | 98516-5534
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Country | US
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Telephone | 360-438-9609
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Fax | 360-456-7380
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 025202-CH00002200
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License Number State | WA
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