1609901545 NPI number — UNIVERSITY PLACE CHIROPRACTIC INC

Table of content: (NPI 1609901545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609901545 NPI number — UNIVERSITY PLACE CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PLACE CHIROPRACTIC INC
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:
1609901545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2607 BRIDGEPORT WAY W
Provider Second Line Business Mailing Address:
SUITE 1D
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-566-2225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2607 BRIDGEPORT WAY W
Provider Second Line Business Practice Location Address:
SUITE 1D
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-566-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
MATTHEU
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
253-566-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00003505 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH00034392 , 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: WI4950 . This is a "REGENCE MATTHEU WILLIAMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0187492 . This is a "L&I THOMAS WILLIAMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 537922990 . This is a "THOMAS WILLIAMS DC TAX ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 117001 . This is a "L&I MATTHEU WILLIAMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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