Provider Demographics
NPI:1285256602
Name:KOTLERMAN FAMILY HEALTH LLC
Entity type:Organization
Organization Name:KOTLERMAN FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-663-5265
Mailing Address - Street 1:1100 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2017
Mailing Address - Country:US
Mailing Address - Phone:310-663-5265
Mailing Address - Fax:
Practice Address - Street 1:320 E FAIRHAVEN AVE STE 209
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1700
Practice Address - Country:US
Practice Address - Phone:360-661-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty