NPIMap

Organization Active NPI

Genesis Chiropractic Rehabilitation NW Inc

  • Chiropractor
  • Puyallup, WA
National Provider Identifier
1184897225
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002989 Issued in WA
Legal business name
GENESIS CHIROPRACTIC REHABILITATION NW INC
Practice address
12815 Canyon Rd E
Suite K
Puyallup, WA 98373-5104
Phone
(253) 256-4769
Fax
(253) 268-2057
NPI assigned
Apr 9, 2008
Last updated
May 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Authorized official

Name
Marc D Hines, D.C.NPI 1710030358
Title
Owner
Phone
(253) 256-4769

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
Chiropractor 111N00000X CH00002989 WA Primary

Addresses

Primary practice location

12815 Canyon Rd E
Suite K
Puyallup, WA 98373-5104

Mailing address

12815 Canyon Rd E
Suite K
Puyallup, WA 98373-5104
Phone (253) 256-4769

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200511003511 WA Part B Supplier - Clinic/Group Practice 6800227695 Receives reassigned benefits from 2 practitioners
Practice locations: Puyallup, WA

National Provider Directory

National Provider Directory

Locations

12815 Canyon Rd E
Ste I
Puyallup, WA 98373
Phone (253) 256-4769

12815 Canyon Rd E
Ste K
Puyallup, WA 98373
Phone (253) 256-4769

8511 Canyon Rd E
Puyallup, WA 98371
Phone (253) 535-3931

Practitioners & affiliated clinicians

Practitioners 10

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": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1184897225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12815 CANYON RD E",
            "address_2": "SUITE K",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983735104",
            "telephone_number": "253-256-4769",
            "fax_number": "253-268-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12815 CANYON RD E",
            "address_2": "SUITE K",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983735104",
            "telephone_number": "253-256-4769",
            "fax_number": "253-268-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS CHIROPRACTIC REHABILITATION NW INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "HINES",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-256-4769",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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.