Provider Demographics
NPI:1215946728
Name:STAMWITZ, KATIE MARIE (DC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MARIE
Last Name:STAMWITZ
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 1:400 WEST WISHKAH
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520
Mailing Address - Country:US
Mailing Address - Phone:360-533-6920
Mailing Address - Fax:360-533-8005
Practice Address - Street 1:400 WEST WISHKAH
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-533-6920
Practice Address - Fax:360-533-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA225421OtherL&I
WA8869076Medicare PIN
WAG8869076Medicare PIN
WA225421OtherL&I