1851413868 NPI number — EDWARD J STEIN DC INC PS

Table of content: (NPI 1851413868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851413868 NPI number — EDWARD J STEIN DC INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J STEIN DC INC PS
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:
STEIN CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1851413868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11109 SE KENT KANGLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98030-7707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-852-1963
Provider Business Mailing Address Fax Number:
253-852-1965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11109 SE KENT KANGLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030-7707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-1963
Provider Business Practice Location Address Fax Number:
253-852-1965
Provider Enumeration Date:
04/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-852-1963

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00000720 , 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)

  • Identifier: 00932 . This is a "WA BS REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 152933152933 . This is a "WA BC PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 12778 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".