NPIMap

Organization Active NPI

Fauntleroy Chiropractic, P.S.

  • Chiropractor
  • Seattle, WA
National Provider Identifier
1225320096
Registry record updated May 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH3113 Issued in WA
Legal business name
FAUNTLEROY CHIROPRACTIC, P.S.
Practice address
4520 Fauntleroy Way SW
Seattle, WA 98126-2740
Phone
(206) 932-6605
Fax
(206) 933-6999
NPI assigned
May 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2011

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

Authorized official

Name
Dr. Bryan Scott Wiebe, D.C.NPI 1790826873
Title
Owner/Chiropractor
Phone
(206) 932-6605

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 CH3113 WA Primary

Addresses

Primary practice location

4520 Fauntleroy Way SW
Seattle, WA 98126-2740

Mailing address

4520 Fauntleroy Way SW
Seattle, WA 98126-2740
Phone (206) 932-6605

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110928000175 WA Part B Supplier - Clinic/Group Practice 5092986877 Receives reassigned benefits from 1 practitioner
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305072000000",
    "number": "1225320096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 FAUNTLEROY WAY SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981262740",
            "telephone_number": "206-932-6605",
            "fax_number": "206-933-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 FAUNTLEROY WAY SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981262740",
            "telephone_number": "206-932-6605",
            "fax_number": "206-933-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAUNTLEROY CHIROPRACTIC, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2011-05-11",
        "status": "A",
        "authorized_official_last_name": "WIEBE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "206-932-6605",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH3113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; 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.