Nolan Deatherage, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH60040685 Issued in WA

Practice address

1101 Supermall Way Ste 1269
Auburn, WA 98001-6535

Phone

(253) 269-0261

NPI assigned

Jan 13, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College - West, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deatherage Chiropractic PLLC

  • Chiropractor
  • Everett, WA
  • NPI 1295497014
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231804800000",
    "number": "1144467119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 SUPERMALL WAY STE 1269",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980016535",
            "telephone_number": "253-269-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 SUPERMALL WAY STE 1269",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980016535",
            "telephone_number": "253-269-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "NOLAN",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-13",
        "last_updated": "2009-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60040685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nicolas De la Torre, M.S., CCC-SLP
• Jennifer Dean
• Jeanette Germaine Decoteau, PAC
• Stephanie Decremer, ATC
• Judi M Dedge, LMP
• William G. Dedge, DC
• Defazio Grewell Acupuncture, Inc.

• Chiropractor in Auburn, WA
• Providers in Auburn, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.