NPIMap

Organization Active NPI

Liberty Lake Chiropractic PS

  • Chiropractor
  • Liberty Lake, WA
National Provider Identifier
1316116262
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH3605 Issued in WA
Legal business name
LIBERTY LAKE CHIROPRACTIC PS
Practice address
2207 N Molter Rd
Suite 250
Liberty Lake, WA 99019-7570
Phone
(509) 893-9939
Fax
(509) 893-9107
NPI assigned
Feb 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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

Authorized official

Name
Amy Truex
Title
Credentialing Manager
Phone
(509) 608-7004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH3605 WA Primary

Addresses

Primary practice location

2207 N Molter Rd
Suite 250
Liberty Lake, WA 99019-7570

Mailing address

2207 N Molter Rd
Suite 250
Liberty Lake, WA 99019-7570
Phone (509) 893-9939

Other names 1

  • Spokane Spine and Disc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080313000094 WA Part B Supplier - Clinic/Group Practice 1658456702 Receives reassigned benefits from 5 practitioners
Practice locations: Liberty Lake, WA

National Provider Directory

National Provider Directory

Locations

2207 N Molter Rd
Ste 250
Liberty Lake, WA 99019
Phone (208) 964-6466

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608163200000",
    "number": "1316116262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD",
            "address_2": "SUITE 250",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197570",
            "telephone_number": "509-893-9939",
            "fax_number": "509-893-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD",
            "address_2": "SUITE 250",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197570",
            "telephone_number": "509-893-9939",
            "fax_number": "509-893-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY LAKE CHIROPRACTIC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A",
        "authorized_official_last_name": "TRUEX",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "509-608-7004"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH3605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spokane Spine and Disc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.