Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60084236 | WA |
NPI | 1003140377 |
---|---|
Provider Name | Dallas Christian Kinch |
First Address | Spokane, WA 99203-4551 |
Second Address | Spokane, WA 99223-7033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2009 |
Last Update Date | 06/03/2010 |