1073571501 NPI number — DR. TY CHARLES WESTENHAVER DC

Table of content: DR. TY CHARLES WESTENHAVER DC (NPI 1073571501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073571501 NPI number — DR. TY CHARLES WESTENHAVER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTENHAVER
Provider First Name:
TY
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1073571501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7127 196TH ST SW
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-775-6986
Provider Business Mailing Address Fax Number:
425-774-3651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7127 196TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-775-6986
Provider Business Practice Location Address Fax Number:
425-774-3651
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00001933 , 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: R75544 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AB04137 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




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