Provider Demographics
NPI:1306064282
Name:GOOTKIND, STEPHEN ALEXANDER (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:GOOTKIND
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 1:4556 KLAHANIE DR SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5812
Mailing Address - Country:US
Mailing Address - Phone:425-391-5050
Mailing Address - Fax:425-391-0758
Practice Address - Street 1:4556 KLAHANIE DR SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98029-5812
Practice Address - Country:US
Practice Address - Phone:425-391-5050
Practice Address - Fax:425-391-0758
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor