NPIMap

Organization Active NPI

Charles C Dwyer DC PC

  • Radiology Chiropractor
  • Clarkston, WA
National Provider Identifier
1114168002
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology ChiropractorTaxonomy code 111NR0200X
License
602884351 Issued in WA
Legal business name
CHARLES C DWYER DC PC
Practice address
919 Highland Ave
Clarkston, WA 99403
Phone
(509) 758-9214
Fax
(509) 758-9267
NPI assigned
Mar 23, 2009
Last updated
Feb 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Mrs. Jodi Marie Dwyer
Title
VP
Phone
(509) 758-9214

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Chiropractor 111NR0200X 602884351 WA Primary

Addresses

Primary practice location

919 Highland Ave
Clarkston, WA 99403

Mailing address

919 Highland Ave
Clarkston, WA 99403
Phone (509) 758-9214

Other names 1

  • Dwyer Chiropractic Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090722000352 WA Part B Supplier - Clinic/Group Practice 9931251998 Receives reassigned benefits from 4 practitioners
Practice locations: Clarkston, WA

National Provider Directory

National Provider Directory

Locations

1013 Bridge St
Ste D
Clarkston, WA 99403
Phone (509) 758-9214

Interoperability endpoints

  • Direct secure messaging: charles@dcc0005.direct.chirotouch.md
  • Direct secure messaging: scott@dcc0005.direct.chirotouch.md

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1114168002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "99403",
            "telephone_number": "509-758-9214",
            "fax_number": "509-758-9267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "99403",
            "telephone_number": "509-758-9214",
            "fax_number": "509-758-9267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES C DWYER DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-23",
        "last_updated": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "509-758-9214",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111NR0200X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Radiology",
            "state": "WA",
            "license": "602884351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dwyer Chiropractic Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clarkston, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.