Provider Demographics
NPI:1164667085
Name:DR. VYACHESLAV A. BORISENKO, D.C., P.S.
Entity type:Organization
Organization Name:DR. VYACHESLAV A. BORISENKO, D.C., P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:BORISENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-520-7531
Mailing Address - Street 1:10024 SE 240TH ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5124
Mailing Address - Country:US
Mailing Address - Phone:253-520-7531
Mailing Address - Fax:253-520-6589
Practice Address - Street 1:10024 SE 240TH ST
Practice Address - Street 2:SUITE 119
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5124
Practice Address - Country:US
Practice Address - Phone:253-520-7531
Practice Address - Fax:253-520-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8852721Medicare PIN