NPIMap

Organization Active NPI

Ichiro PLLC

  • Chiropractor
  • Bonney Lake, WA
National Provider Identifier
1114372117
Registry record updated Apr 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60039572 Issued in WA
Legal business name
ICHIRO PLLC
Practice address
18008 State Route 410 E
Suite D
Bonney Lake, WA 98391-7113
Phone
(253) 447-8440
Fax
(253) 987-7444
NPI assigned
Apr 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2016

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

Authorized official

Name
Jeff Barnes
Title
Manager
Phone
(425) 614-9939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH60039572 WA Primary

Addresses

Primary practice location

18008 State Route 410 E
Suite D
Bonney Lake, WA 98391-7113

Mailing address

18008 State Route 410 E
Suite D
Bonney Lake, WA 98391-7113
Phone (253) 447-8440

Other names 1

  • Ideal Motion Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240802002585 WA Part B Supplier - Clinic/Group Practice 1153777610 Receives reassigned benefits from 3 practitioners
Practice locations: Bonney Lake, WA

National Provider Directory

National Provider Directory

Locations

18008 State Route 410 E
Ste D
Bonney Lake, WA 98391
Phone (253) 447-8440

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": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461715200000",
    "number": "1114372117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18008 STATE ROUTE 410 E",
            "address_2": "SUITE D",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917113",
            "telephone_number": "253-447-8440",
            "fax_number": "253-987-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18008 STATE ROUTE 410 E",
            "address_2": "SUITE D",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917113",
            "telephone_number": "253-447-8440",
            "fax_number": "253-987-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICHIRO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "425-614-9939"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60039572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ideal Motion Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; 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.