MEDICARE: SUDEVI KISH LMP

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	111N00000X	Chiropractor	MA 60126141	WA

General Provider Information

NPI Number	:	1558684019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUDEVI KISH LMP

Provider Business Mailing Address
First Line	:	8856 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8856 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106
Country	:	US
Telephone Number	:	206-446-1709
Fax Number	:

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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