NPIMap

Organization Active NPI

Chan Chiropractic Clinic, P.S.

  • Chiropractor
  • Kennewick, WA
National Provider Identifier
1235255662
Registry record updated Feb 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
080370 Issued in WA
Legal business name
CHAN CHIROPRACTIC CLINIC, P.S.
Practice address
4339 W Kennewick Ave
Kennewick, WA 99336-2802
Phone
(509) 735-0311
Fax
(509) 783-1206
NPI assigned
Mar 21, 2007
Last updated
Feb 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2008

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

Authorized official

Name
Dr. Theodore W Chan, DCNPI 1144307703
Title
President
Phone
(509) 735-0311

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 080370 WA Primary

Addresses

Primary practice location

4339 W Kennewick Ave
Kennewick, WA 99336-2802

Mailing address

4339 W Kennewick Ave
Kennewick, WA 99336-2802
Phone (509) 735-0311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080225000610 WA Part B Supplier - Clinic/Group Practice 4981788239 Receives reassigned benefits from 3 practitioners
Practice locations: Kennewick, WA

National Provider Directory

National Provider Directory

Locations

4339 W Kennewick Ave
Kennewick, WA 99336
Phone (509) 735-0311

Practitioners & affiliated clinicians

Practitioners 11

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": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1235255662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4339 W KENNEWICK AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993362802",
            "telephone_number": "509-735-0311",
            "fax_number": "509-783-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4339 W KENNEWICK AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993362802",
            "telephone_number": "509-735-0311",
            "fax_number": "509-783-1206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAN CHIROPRACTIC CLINIC, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-735-0311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "080370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.