NPIMap

Organization Active NPI

Edmark Chiropractic PLLC

  • Chiropractor
  • Lake Stevens, WA
National Provider Identifier
1144699190
Registry record updated Sep 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002100 Issued in WA
Legal business name
EDMARK CHIROPRACTIC PLLC
Practice address
10519 20TH St SE
Suite 1
Lake Stevens, WA 98258-4768
Phone
(425) 397-4900
Fax
(425) 397-6900
NPI assigned
Sep 21, 2015
Last updated
Sep 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2015

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

Authorized official

Name
Kurt A Edmark, D.C.NPI 1790803468
Title
Owner
Phone
(425) 397-4900

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 SINGLE SPECIALTY GROUP 111N00000X CH00002100 WA Primary

Addresses

Primary practice location

10519 20TH St SE
Suite 1
Lake Stevens, WA 98258-4768

Mailing address

10519 20TH St SE
Suite 1
Lake Stevens, WA 98258-4768
Phone (425) 397-4900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151027003357 WA Part B Supplier - Clinic/Group Practice 6608185962 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Stevens, WA

National Provider Directory

National Provider Directory

Locations

10519 20th St SE
Ste 1
Lake Stevens, WA 98258
Phone (425) 397-4900

Practitioners & affiliated clinicians

Practitioners 3

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": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442793600000",
    "number": "1144699190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10519 20TH ST SE",
            "address_2": "SUITE 1",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982584768",
            "telephone_number": "425-397-4900",
            "fax_number": "425-397-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10519 20TH ST SE",
            "address_2": "SUITE 1",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982584768",
            "telephone_number": "425-397-4900",
            "fax_number": "425-397-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMARK CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2015-09-21",
        "status": "A",
        "authorized_official_last_name": "EDMARK",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-397-4900",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Stevens, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.