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NPI Code Detail

MEDICARE: ERIC KLOS D.C, C.C.N

MEDICARE: ERIC KLOS D.C, C.C.N
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
1111NN1001XNutrition Chiropractor63098WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
163098OTHERWAL&I #
22542OTHERWALICENSE NUMBER

General Provider Information

NPI Number : 1689884819
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC KLOS D.C, C.C.N
Provider Business Mailing Address
First Line : 634 7TH AVE
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-5665
Country : US
Telephone Number : 425-822-2858
Fax Number : 425-822-5611
Provider Business Practice Location Address
First Line : 634 7TH AVE
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-5665
Country : US
Telephone Number : 425-822-2858
Fax Number : 425-822-5611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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