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General NPI Number Information
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NPI Number | 1649817354
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Entity Type | Organization
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Legal Business Name | KITSAP SPINE AND WELLNESS PLLC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 3888 NW RANDALL WAY STE 202
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City | SILVERDALE
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State | WA
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Zip | 98383-7847
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Country | US
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Telephone | 360-377-1626
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Fax | 360-377-1903
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Provider Business Mailing Address
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Address Line | 3888 NW RANDALL WAY STE 202
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City | SILVERDALE
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State | WA
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Zip | 98383-7847
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Country | US
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Telephone | 360-377-1626
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Fax | 360-377-1903
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARK THOMAS GOODMAN
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Credential | DC
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Telephone | 360-377-1626
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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 |
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License Number State |
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