Organization Active NPI

Planet Chiropractic Inc

  • Chiropractor
  • Mill Creek, WA
National Provider Identifier
1033443791
Registry record updated Sep 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PLANET CHIROPRACTIC INC
Practice address
15224 Main St Ste 103
Mill Creek, WA 98012-7316
Phone
(425) 760-2205
Fax
(425) 379-0180
NPI assigned
Sep 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2009

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

Authorized official

Name
Dr. Justin Keith McCormick, DCNPI 1932235561
Title
Owner
Phone
(425) 760-2205

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

15224 Main St Ste 103
Mill Creek, WA 98012-7316

Mailing address

15224 Main St Ste 103
Mill Creek, WA 98012-7316
Phone (425) 760-2205

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091124000031 WA Part B Supplier - Clinic/Group Practice 6305985870 Receives reassigned benefits from 1 practitioner
Practice locations: Mill Creek, WA

National Provider Directory

National Provider Directory
Tax ID family
Planet Chiropractic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15224 Main St
Ste 103
Mill Creek, WA 98012
Phone (425) 379-9749

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1033443791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15224 MAIN ST STE 103",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980127316",
            "telephone_number": "425-760-2205",
            "fax_number": "425-379-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15224 MAIN ST STE 103",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980127316",
            "telephone_number": "425-760-2205",
            "fax_number": "425-379-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLANET CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-29",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-760-2205",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; 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.