Provider Demographics
NPI:1053404038
Name:KOONER, RAYMON (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMON
Middle Name:
Last Name:KOONER
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 1:10655 NE 4TH ST
Mailing Address - Street 2:101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5035
Mailing Address - Country:US
Mailing Address - Phone:503-860-8859
Mailing Address - Fax:
Practice Address - Street 1:10655 NE 4TH ST
Practice Address - Street 2:101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5035
Practice Address - Country:US
Practice Address - Phone:503-860-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHOOO34656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6498900001Medicare NSC