Puyallup Chiropractic Clinic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00002891 Issued in WA

Legal business name

PUYALLUP CHIROPRACTIC CLINIC

Practice address

111 East Stewart Ave
Puyalluup, WA 98372

Phone

(253) 845-0543

Fax

(253) 848-6788

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Lynn Terry, DCNPI 1477616811

Title

Owner Doctor

Phone

(253) 845-0543

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Lynn Terry, D.C.

  • Chiropractor
  • Puyallup, WA
  • NPI 1477616811
  Medicare reassignment Care Compare group NPD Authorized official
• Tyson Terry

  • Chiropractor
  • Puyallup, WA
  • NPI 1255728291
  Medicare reassignment Care Compare group NPD
• Rodney Marc Meeker, D.C.

  • Chiropractor
  • Puyallup, WA
  • NPI 1639274665
  NPD
• Seth Thomas Englebert, LMT

  • Massage Therapist
  • Puyallup, WA
  • NPI 1003563206
  NPD (past)
• Jason Michael Epeneter, D.C.

  • Chiropractor
  • Tacoma, WA
  • NPI 1043429616
  NPD (past)
• Maria Elizabeth Sauers, LMP

  • Specialist
  • Puyallup, WA
  • NPI 1558425934
  NPD (past)
• Derrol Marvin Sillito, DC

  • Chiropractor
  • Puyallup, WA
  • NPI 1992704910
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1164599601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 EAST STEWART AVE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "98372",
            "telephone_number": "253-845-0543",
            "fax_number": "253-848-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 EAST STEWART AVE",
            "city": "PUYALLUUP",
            "state": "WA",
            "postal_code": "98372",
            "telephone_number": "253-845-0543",
            "fax_number": "253-848-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "253-845-0543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "TE6127",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.