Individual provider Active NPI

David Warren Middendorf, D.C.

  • Chiropractor
  • Port Orchard, WA
National Provider Identifier
1366483737
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH1706 Issued in WA
Practice address
4255 SE Mile Hill Dr
Suite101
Port Orchard, WA 98366-3920
Phone
(360) 871-5200
Fax
(360) 871-5350
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH1706 WA Primary

Addresses

Primary practice location

4255 SE Mile Hill Dr
Suite101
Port Orchard, WA 98366-3920

Mailing address

PO Box 525
Port Orchard, WA 98366-0525
Phone (360) 871-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH1706WAMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1366483737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 525",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983660525",
            "telephone_number": "360-871-5200",
            "fax_number": "360-871-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 SE MILE HILL DR",
            "address_2": "SUITE101",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663920",
            "telephone_number": "360-871-5200",
            "fax_number": "360-871-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDENDORF",
        "first_name": "DAVID",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH1706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; 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.