Provider Demographics
NPI:1992174866
Name:KASIM, KELILA (DC)
Entity type:Individual
Prefix:DR
First Name:KELILA
Middle Name:
Last Name:KASIM
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 1:5429 RUSSELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4010
Mailing Address - Country:US
Mailing Address - Phone:206-782-8500
Mailing Address - Fax:
Practice Address - Street 1:15248 SUNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2444
Practice Address - Country:US
Practice Address - Phone:206-261-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60562994111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition