Provider Demographics
NPI:1083799951
Name:WASHINGTON, KELVIN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:MICHAEL
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1154
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-1154
Mailing Address - Country:US
Mailing Address - Phone:303-838-2443
Mailing Address - Fax:303-838-2443
Practice Address - Street 1:25797 CONIFER RD STE B211
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9052
Practice Address - Country:US
Practice Address - Phone:303-838-2443
Practice Address - Fax:303-838-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46113Medicare ID - Type Unspecified