Provider Demographics
NPI:1730984303
Name:WILMOVSKY, ETHAN JETT (DC)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:JETT
Last Name:WILMOVSKY
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 1:704 DENNIS ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5527
Mailing Address - Country:US
Mailing Address - Phone:360-481-0544
Mailing Address - Fax:
Practice Address - Street 1:2627 CAPITAL MALL DR SW # B-3A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8696
Practice Address - Country:US
Practice Address - Phone:360-786-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61662847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor