Provider Demographics
NPI:1154805745
Name:BURNETTE, KAITLYN LYELL (DC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LYELL
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 MERIDIAN AVE N APT A105
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9534
Mailing Address - Country:US
Mailing Address - Phone:919-332-3465
Mailing Address - Fax:
Practice Address - Street 1:400 N 34TH ST STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8600
Practice Address - Country:US
Practice Address - Phone:206-536-3500
Practice Address - Fax:206-536-3505
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60833134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor