NPIMap

Organization Active NPI

Pacific Wellness and Spa Inc

  • Rehabilitation Chiropractor
  • University Place, WA
National Provider Identifier
1437356201
Registry record updated Feb 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
CO5411 Issued in WA
Legal business name
PACIFIC WELLNESS AND SPA INC
Practice address
4114 Bridgeport Way W
University Place, WA 98466
Phone
(253) 564-8100
Fax
(253) 564-8387
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2008

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

Authorized official

Name
Dr. Edward D Corley, DC
Title
Chiropractor
Phone
(253) 564-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NR0400X CO5411 WA Primary

Addresses

Primary practice location

4114 Bridgeport Way W
University Place, WA 98466

Mailing address

4114 Bridgeport Way W
University Place, WA 98466
Phone (253) 564-8100

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1437356201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4114 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "98466",
            "telephone_number": "253-564-8100",
            "fax_number": "253-564-8387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4114 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "98466",
            "telephone_number": "253-564-8100",
            "fax_number": "253-564-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC WELLNESS AND SPA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "CORLEY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "253-564-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "WA",
            "license": "CO5411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; 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.