Basic Information
| Provider Information | |||||||||
| NPI: | 1003140377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINCH | ||||||||
| FirstName: | DALLAS | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
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| Credential: | L.M.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2381 S SOUTHEAST BLVD | ||||||||
| Address2: | APARTMENT 3 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992034551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093385982 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3022 E 57TH AVE | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992237033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093385982 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2009 | ||||||||
| LastUpdateDate: | 03/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA60084236 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.