Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MA60294423 | WA |
NPI | 1265780118 |
---|---|
Provider Name | Miss Kacey Stephen Kisler |
First Address | Moses Lake, WA 98837-1719 |
Second Address | Moses Lake, WA 98837-1719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 27/08/2012 |