NPIMap

Organization Active NPI

Athletes Performance Center PS

Doing business as Kinetic Sports Rehab

  • Sports Physician Chiropractor
  • Seattle, WA
National Provider Identifier
1013200492
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
CH00034592
Legal business name
ATHLETES PERFORMANCE CENTER PS
Doing business as
Kinetic Sports Rehab
Tangelo Manual Therapy & Movement
Practice address
4755 Fauntleroy Way SW Ste 120
Seattle, WA 98116-4669
Phone
(206) 946-1323
Fax
(206) 926-7908
NPI assigned
May 18, 2011
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael D Bourbonnais, D.C.NPI 1801966270
Title
Owner
Phone
(206) 522-6240

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH00003244 WA
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X CH00034592 Primary

Addresses

Primary practice location

4755 Fauntleroy Way SW Ste 120
Seattle, WA 98116-4669

Mailing address

7116 Woodlawn Ave NE
Seattle, WA 98115-5435
Phone (206) 522-6240

Other practice location 1

7116 Woodlawn Ave NE
Seattle, WA 98115-5435
Phone (206) 522-6240

Other names 2

  • Kinetic Sports Rehab Doing business as
  • Tangelo Manual Therapy & Movement Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110602000642 WA Part B Supplier - Clinic/Group Practice 6709063571 Receives reassigned benefits from 7 practitioners
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory

Locations

29034 216th Ave SE
Ste 1
Black Diamond, WA 98010

27203 216th Ave SE
Ste 10
Maple Valley, WA 98038
Phone (253) 656-0078

4755 Fauntleroy Way SW
Ste 120
Seattle, WA 98116
Phone (206) 946-1323

701 N 36th St
Ste 430
Seattle, WA 98103
Phone (206) 547-0707

7116 Woodlawn Ave NE
Seattle, WA 98115
Phone (206) 522-6240

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1013200492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7116 WOODLAWN AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981155435",
            "telephone_number": "206-522-6240",
            "fax_number": "206-926-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 FAUNTLEROY WAY SW STE 120",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164669",
            "telephone_number": "206-946-1323",
            "fax_number": "206-926-7908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7116 Woodlawn Ave NE",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981155435",
            "country_code": "US",
            "telephone_number": "206-522-6240",
            "fax_number": "206-926-7899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATHLETES PERFORMANCE CENTER PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "BOURBONNAIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-522-6240",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003244",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": "CH00034592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinetic Sports Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kinetic Sports Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tangelo Manual Therapy & Movement",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.