1164602470 NPI number — RICHARD D LEONE CHIROPRACTIC CENTER, INC., P.S.

Table of content: (NPI 1164602470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164602470 NPI number — RICHARD D LEONE CHIROPRACTIC CENTER, INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD D LEONE CHIROPRACTIC CENTER, INC., P.S.
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:
6
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:
1164602470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98508-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-471-1287
Provider Business Mailing Address Fax Number:
253-471-1290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 S 72ND ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98408-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-471-1287
Provider Business Practice Location Address Fax Number:
253-471-1290
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEONE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
253-471-1287

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00000775 , 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: 350022640 . This is a "MEDICARE RR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7802LE . This is a "REGENCE RIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0204807 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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