MEDICARE: DR. LINCOLN KAMELL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	2489	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	911805909	OTHER	WA	TAX ID

General Provider Information

NPI Number	:	1164457123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINCOLN KAMELL D.C.

Provider Business Mailing Address
First Line	:	2946 EASTLAKE AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3010
Country	:	US
Telephone Number	:	206-324-8600
Fax Number	:	206-322-8520

Provider Business Practice Location Address
First Line	:	2946 EASTLAKE AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3010
Country	:	US
Telephone Number	:	206-324-8600
Fax Number	:	206-322-8520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/28/2022

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