NPIMap

Organization Active NPI

Mittelstaedt Chiropractic Inc

  • Chiropractor
  • Port Angeles, WA
National Provider Identifier
1376660050
Registry record updated Dec 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1365 Issued in WA
Legal business name
MITTELSTAEDT CHIROPRACTIC INC
Doing business as
Mittelstaedt Chiropractic
Practice address
601 S Race St
Suite C
Port Angeles, WA 98362-6400
Phone
(360) 452-7636
Fax
(360) 457-4221
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2007

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

Authorized official

Name
Dr. Brian William Mittelstaedt, D.C.
Title
Doctor-Owner
Phone
(360) 452-7636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 1365 WA Primary

Addresses

Primary practice location

601 S Race St
Suite C
Port Angeles, WA 98362-6400

Mailing address

601 S Race St
Suite C
Port Angeles, WA 98362-6400
Phone (360) 452-7636

Other identifiers 1

IdentifierTypeStateIssuer
2040400MedicaidWA

Other names 1

  • Mittelstaedt Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

601 S Race St
Ste C
Port Angeles, WA 98362
Phone (360) 452-7636

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198627200000",
    "number": "1376660050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S RACE ST",
            "address_2": "SUITE C",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626400",
            "telephone_number": "360-452-7636",
            "fax_number": "360-457-4221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S RACE ST",
            "address_2": "SUITE C",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626400",
            "telephone_number": "360-452-7636",
            "fax_number": "360-457-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITTELSTAEDT CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "MITTELSTAEDT",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DOCTOR-OWNER",
        "authorized_official_telephone_number": "360-452-7636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "1365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2040400",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mittelstaedt Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Angeles, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.