Provider Demographics
NPI:1346738408
Name:GONSTEAD CHIROPRACTIC OF SEATTLE PC
Entity type:Organization
Organization Name:GONSTEAD CHIROPRACTIC OF SEATTLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-957-7950
Mailing Address - Street 1:13028 INTERURBAN AVE S STE 106
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3340
Mailing Address - Country:US
Mailing Address - Phone:206-957-7950
Mailing Address - Fax:206-957-7952
Practice Address - Street 1:13028 INTERURBAN AVE S STE 106
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3340
Practice Address - Country:US
Practice Address - Phone:206-957-7950
Practice Address - Fax:206-957-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60502337111N00000X
WAMA60036391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty