=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932469657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FINESSE CHIROPRACTIC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2012
-----------------------------------------------------
Last Update Date | 11/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 CORPORATE CENTER LOOP SE STE K11
-----------------------------------------------------
City | LACEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98503-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-918-8782
-----------------------------------------------------
Fax | 360-972-2096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5401 CORPORATE CENTER LOOP SE STE R
-----------------------------------------------------
City | LACEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98503-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-918-8782
-----------------------------------------------------
Fax | 360-972-2096
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARVIN I KUNIKIYO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 360-918-8782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH000002656
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------