NPIMap

Organization Active NPI

Maple Valley Chiropractic and Massage, Inc.

  • Chiropractor
  • Maple Valley, WA
National Provider Identifier
1396025870
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00034707 Issued in WA
Legal business name
MAPLE VALLEY CHIROPRACTIC AND MASSAGE, INC.
Practice address
23220 Maple Valley Black Diamond Rd SE
Suite 13
Maple Valley, WA 98038-5225
Phone
(425) 432-1449
Fax
(425) 432-9910
NPI assigned
Aug 28, 2011
Last updated
Oct 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Authorized official

Name
Dr. Ryan Donovan, D.C.NPI 1376669341
Title
President
Phone
(480) 789-0872

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00034707 WA Primary

Addresses

Primary practice location

23220 Maple Valley Black Diamond Rd SE
Suite 13
Maple Valley, WA 98038-5225

Mailing address

23220 Maple Valley Black Diamond Rd SE
Suite 13
Maple Valley, WA 98038-5225
Phone (425) 432-1449

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111025000505 WA Part B Supplier - Clinic/Group Practice 0648443366 Receives reassigned benefits from 1 practitioner
Practice locations: Maple Valley, WA

National Provider Directory

National Provider Directory

Locations

23220 Maple Valley Black Diamond Rd SE
Ste 13
Maple Valley, WA 98038
Phone (425) 432-1449

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1396025870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23220 MAPLE VALLEY BLACK DIAMOND RD SE",
            "address_2": "SUITE 13",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980385225",
            "telephone_number": "425-432-1449",
            "fax_number": "425-432-9910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23220 MAPLE VALLEY BLACK DIAMOND RD SE",
            "address_2": "SUITE 13",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980385225",
            "telephone_number": "425-432-1449",
            "fax_number": "425-432-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE VALLEY CHIROPRACTIC AND MASSAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-28",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "DONOVAN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-789-0872",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.