NPIMap

Organization Active NPI

Brilliant Life Chiropractic, LLC

  • Chiropractor
  • Tacoma, WA
National Provider Identifier
1063666444
Registry record updated Jan 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00034780 Issued in WA
Legal business name
BRILLIANT LIFE CHIROPRACTIC, LLC
Practice address
708 Broadway Ste 403
Tacoma, WA 98402
Phone
(253) 383-0577
Fax
(253) 383-0574
NPI assigned
Nov 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2020

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

Authorized official

Name
Dr. Paul William Martin, D.C.NPI 1720225311
Title
Owner
Phone
(253) 383-0577

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: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH00034780 WA Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH00034834 WA

Addresses

Primary practice location

708 Broadway Ste 403
Tacoma, WA 98402

Mailing address

708 Broadway Ste 403
Tacoma, WA 98402-3781
Phone (253) 383-0577

Other practice location 1

2610 6th Ave
Tacoma, WA 98406-7205
Phone (253) 383-0577

Other practice location 2

2610 6th Ave
Tacoma, WA 98406-7205
Phone (253) 383-0577

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090128000379 WA Part B Supplier - Clinic/Group Practice 4587728092 Receives reassigned benefits from 2 practitioners
Practice locations: Tacoma, WA

National Provider Directory

National Provider Directory

Locations

2610 6th Ave
#A
Tacoma, WA 98406
Phone (253) 383-0577

2610 6th Ave
Tacoma, WA 98406
Phone (253) 383-0577

708 Broadway
Ste 403
Tacoma, WA 98402
Phone (253) 383-0577

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": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578960000000",
    "number": "1063666444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 BROADWAY STE 403",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023781",
            "telephone_number": "253-383-0577",
            "fax_number": "253-383-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 BROADWAY STE 403",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98402",
            "telephone_number": "253-383-0577",
            "fax_number": "253-383-0574"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2610 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984067205",
            "country_code": "US",
            "telephone_number": "253-383-0577",
            "fax_number": "253-383-0574",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2610 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984067205",
            "country_code": "US",
            "telephone_number": "253-383-0577",
            "fax_number": "253-383-0574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRILLIANT LIFE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-11",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-383-0577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034780",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034834",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; 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.