1356565444 NPI number — MATHENY CHIROPRACTIC CENTER

Table of content: (NPI 1356565444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356565444 NPI number — MATHENY CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATHENY CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MATHENY CHIROPRACTIC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356565444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 108TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-5578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-452-9280
Provider Business Mailing Address Fax Number:
425-452-9306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 108TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-5578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-452-9280
Provider Business Practice Location Address Fax Number:
425-452-9306
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATHENY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIROPRACTIC
Authorized Official Telephone Number:
425-452-9280

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA00021246 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)