NPIMap

Organization Active NPI

Living Well Chiropractic & Massage Inc.

  • Chiropractor
  • Bainbridge Island, WA
National Provider Identifier
1063819712
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60503164 Issued in WA
Legal business name
LIVING WELL CHIROPRACTIC & MASSAGE INC.
Practice address
363 Tormey LN NE
Suite 210
Bainbridge Island, WA 98110-2895
Phone
(206) 842-4929
Fax
(206) 842-4920
NPI assigned
Nov 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Authorized official

Name
Brian KovaraNPI 1942237102
Title
Owner
Phone
(206) 842-4929

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 MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH60503164 WA Primary

Addresses

Primary practice location

363 Tormey LN NE
Suite 210
Bainbridge Island, WA 98110-2895

Mailing address

363 Tormey LN NE
Suite 210
Bainbridge Island, WA 98110-2895

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150629002923 WA Part B Supplier - Clinic/Group Practice 3779895081 Receives reassigned benefits from 2 practitioners
Practice locations: Bainbridge Island, WA

National Provider Directory

National Provider Directory

Locations

200 Winslow Way W
Unit 200
Bainbridge Island, WA 98110
Phone (206) 842-4929

363 Tormey Ln NE
Ste 210
Bainbridge Island, WA 98110
Phone (206) 842-4929

Practitioners & affiliated clinicians

Practitioners 6

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": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1063819712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 TORMEY LN NE",
            "address_2": "SUITE 210",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 TORMEY LN NE",
            "address_2": "SUITE 210",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102895",
            "telephone_number": "206-842-4929",
            "fax_number": "206-842-4920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL CHIROPRACTIC & MASSAGE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-24",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "KOVARA",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-842-4929"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60503164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bainbridge Island, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; 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.