Provider Demographics
NPI:1306164439
Name:KI CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:KI CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-409-9447
Mailing Address - Street 1:12000 15TH AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5083
Mailing Address - Country:US
Mailing Address - Phone:206-409-9447
Mailing Address - Fax:206-363-1390
Practice Address - Street 1:12000 15TH AVE NE STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5093
Practice Address - Country:US
Practice Address - Phone:206-409-9447
Practice Address - Fax:206-363-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty