1073666780 NPI number — MILE HILL CHIROPRACTIC

Table of content: (NPI 1073666780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073666780 NPI number — MILE HILL CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILE HILL 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:
1073666780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-0525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-871-5200
Provider Business Mailing Address Fax Number:
360-871-5350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4519 SE MILE HILL DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-871-5200
Provider Business Practice Location Address Fax Number:
360-871-5350
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MIDDENDORF
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER CHIROPRACTOR
Authorized Official Telephone Number:
360-871-5200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1706 , 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: 66982 . This is a "DR JOYCE LABOR INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 138013 . This is a "LMP CINDY LI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0152874 . This is a "LMP AMANDA LI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0169804 . This is a "LMP ARIN LI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 60732 . This is a "DR DAVES LABOR INDUSTRIE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com