# AXIS SPINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134948458
- **Authorized official:** KENNETH NWOSU MD (SPINE SURGEON)
- **Authorized official phone:** (909) 659-1852

## Contact information

- **Practice address:** 1519 3RD ST SE STE 101, PUYALLUP, WA 98372-3742
- **Practice address phone:** (909) 659-1852
- **Mailing address:** 1101 N 39TH CT, RENTON, WA 98056-1624
- **Mailing address phone:** (909) 659-1852

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/03/2024
- **Last updated:** 10/03/2024