Axis Chiropractic Clinic, PS

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00002546 Issued in WA

Legal business name

AXIS CHIROPRACTIC CLINIC, PS

Practice address

3459 S 152ND St
Tukwila, WA 98188-2176

Phone

(206) 241-2225

Fax

(206) 241-5562

NPI assigned

Dec 26, 2012

Organization subpart

Yes

Parent organization

AXIS CHIROPRACTIC CLINIC, PSAs reported in NPPES

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

Authorized official

Name

Vernon Howard Kaczmarski, D.C.NPI 1669512455

Title

Chiropractor

Phone

(206) 241-2225

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Part of

Axis Chiropractic Clinic PS

Practitioners 1

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

• Vernon Howard Kaczmarski, D.C.

  • Chiropractor
  • Tukwila, WA
  • NPI 1669512455
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1245576008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3459 S 152ND ST",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882176",
            "telephone_number": "206-241-2225",
            "fax_number": "206-241-5562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3459 S 152ND ST",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882176",
            "telephone_number": "206-241-2225",
            "fax_number": "206-241-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS CHIROPRACTIC CLINIC, PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AXIS CHIROPRACTIC CLINIC, PS",
        "enumeration_date": "2012-12-26",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "KACZMARSKI",
        "authorized_official_first_name": "VERNON",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "206-241-2225",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR & INDUSTRIES",
            "identifier": "0306831",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN WHOLEHEALTH NETWORK",
            "identifier": "391945651",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "KA0067",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2014876",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ariga Avanessian, DMD
• Nicole Ayamanjemi Mbouemboue
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• Nazeleeh Bacuyag
• Theresa Badour
• Amanda Paige Bailey, M.A., L.M.H.C.

• Chiropractor in Tukwila, WA
• Providers in Tukwila, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.