1770085649 NPI number — BELLA VITA CHIROPRACTIC

Table of content: (NPI 1770085649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770085649 NPI number — BELLA VITA CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLA VITA CHIROPRACTIC
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:
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:
1770085649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7307 43RD AVENUE CT NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-8304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-442-2108
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11505 BURNHAM DR NW STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98332-9173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-442-2108
Provider Business Practice Location Address Fax Number:
360-668-5673
Provider Enumeration Date:
03/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SALMON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
425-442-2108

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH60509530 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1821496746 . This is a "NPPES" identifier . This identifiers is of the category "OTHER".




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