Blue Heron Chiropractic, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

CH60517781 Issued in WA

Legal business name

BLUE HERON CHIROPRACTIC, LLC

Doing business as

Blue Heron Chiropractic

Practice address

716 3Rd St Unit B
Mukilteo, WA 98275-1548

Phone

(425) 616-2440

Fax

(425) 332-7078

NPI assigned

Nov 15, 2017

Last updated

Nov 15, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Claire Russell, DC

Title

Owner

Phone

(425) 616-2440

Specialties & licenses 1

Addresses

Other names 1

• Blue Heron Chiropractic Doing business as

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1275046062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19308 76TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980266201",
            "telephone_number": "425-750-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 3RD ST UNIT B",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982751548",
            "telephone_number": "425-616-2440",
            "fax_number": "425-332-7078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-15",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "CLAIRE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-616-2440",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "WA",
            "license": "CH60517781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Heron Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angela M Bettencourt, PT
• Ron E Bettencourt, PT, CSCS
• Niharika Kaur Bhooi
• Christoper J Bibby, MD
• Blooming Speech P.S.
• Quincy Bolden
• Agnes Ayap Borjal, PT
• Jeanne M Bourget
• Amy Marie Braden, LMP
• Danielle H Bradshaw, LMHC, LCPC

• Health Service Clinic/Center in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Health Service Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.