Provasoli Chiropractic Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

60741817 Issued in WA

Legal business name

PROVASOLI CHIROPRACTIC INC.

Practice address

1018 7TH Ave SE
Olympia, WA 98501-1512

Phone

(360) 459-8114

NPI assigned

Feb 1, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Mark Den Hartog, DC

Title

Owner/Chiropractor

Phone

(515) 822-0405

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Provasoli Chiropractic Doing business as

Locations

Practitioners 3

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

• Jan Pfeffer Berney, M.ED., LMHC

  • Mental Health Counselor
  • Olympia, WA
  • NPI 1962553388
  NPD (past)
• Robert Provasoli, D.C.

  • Chiropractor
  • Olympia, WA
  • NPI 1891861001
  NPD (past)
• Shamika Cordis, D.C.

  • Chiropractor
  • Chicago, IL
  • NPI 1457642936
  NPD (past)

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1366940645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 7TH AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011512",
            "telephone_number": "515-822-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 7TH AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011512",
            "telephone_number": "360-459-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVASOLI CHIROPRACTIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "DEN HARTOG",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "515-822-0405",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "60741817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTOR",
            "identifier": "1023081155",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provasoli Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Toni Jo Principe, LICSW
• Brent Proctor, PT
• Kayla Marie Proctor, CRNA
• Professional Resource Network 365 PLLC
• Prolific Well
• Judith Freed Provasoli, L.M.H.C.
• Robert Provasoli, D.C.
• Providence Health & Services - Washington
• Providence Health & Services Washington
• Providence Health & Services Washington

• Clinic/Center in Olympia, WA
• Providers in Olympia, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; 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.