Provider Demographics
NPI:1447355482
Name:KUNIKIYO, MARVIN I (DC)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:I
Last Name:KUNIKIYO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 CORPORATE CENTER LOOP SE
Mailing Address - Street 2:STE R
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5606
Mailing Address - Country:US
Mailing Address - Phone:360-918-8782
Mailing Address - Fax:360-972-2096
Practice Address - Street 1:5401 CORPORATE CENTER LOOP SE
Practice Address - Street 2:STE R
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5606
Practice Address - Country:US
Practice Address - Phone:360-918-8782
Practice Address - Fax:360-972-2096
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA173617OtherLABOR & INDUSTRIES