Edmonds-Woodway Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH60443467 Issued in WA

Legal business name

EDMONDS-WOODWAY CHIROPRACTIC LLC

Practice address

7631 212TH St SW
105B
Edmonds, WA 98026-7565

Phone

(903) 742-1072

Fax

(425) 775-9608

NPI assigned

Oct 29, 2014

Organization subpart

No

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

Authorized official

Name

Kristopher Marty Lane, DC

Title

Owner

Phone

(903) 742-1072

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1083019301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7631 212TH ST SW",
            "address_2": "105B",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267565",
            "telephone_number": "903-742-1072",
            "fax_number": "425-775-9608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7631 212TH ST SW",
            "address_2": "105B",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267565",
            "telephone_number": "903-742-1072",
            "fax_number": "425-775-9608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMONDS-WOODWAY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-29",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_middle_name": "MARTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-742-1072",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60443467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0325925",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Edmonds, WA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.