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Organization Active NPI

Lake Stevens Chiropractic, PLLC

Doing business as Lake Stevens Chiropractic

  • Chiropractor
  • Lake Stevens, WA
National Provider Identifier
1467592741
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00000734 Issued in WA
Legal business name
LAKE STEVENS CHIROPRACTIC, PLLC
Doing business as
Lake Stevens Chiropractic
Practice address
905 State Route 9 NE
Lake Stevens, WA 98258-9484
Phone
(425) 334-5066
Fax
(425) 335-4787
NPI assigned
Feb 7, 2007
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Peter Hanson, DCNPI 1356495303
Title
Owner
Phone
(425) 334-5066

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH00000734 WA Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH00001249 WA
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH0002638 WA

Addresses

Primary practice location

905 State Route 9 NE
Lake Stevens, WA 98258-9484

Mailing address

905 Sr 9 NE
Lake Stevens, WA 98258-9484
Phone (425) 334-5066

Other identifiers 10

IdentifierTypeStateIssuer
11170071OtherWACAQH
2026931MedicaidWA
2016458MedicaidWA
8864765OtherWAMEDICARE DR GADDIS
13819800OtherWACAQH
12014OtherWALABOR & INDUSTRIES
2319903MedicaidWA
0291162OtherWADEPT. OF LABOR & INDUSTRIES
12346880OtherWACAQH
0353640OtherWADEPT. OF LABOR & INDUSTRIES

Other names 1

  • Lake Stevens Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

905 State Route 9 NE
Lake Stevens, WA 98258
Phone (425) 334-5066

Practitioners & affiliated clinicians

Practitioners 6

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": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1467592741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 SR 9 NE",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982589484",
            "telephone_number": "425-334-5066",
            "fax_number": "425-335-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 STATE ROUTE 9 NE",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982589484",
            "telephone_number": "425-334-5066",
            "fax_number": "425-335-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STEVENS CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-334-5066",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00000734",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00001249",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH0002638",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11170071",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2026931",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016458",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DR GADDIS",
            "identifier": "8864765",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13819800",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "12014",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2319903",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR & INDUSTRIES",
            "identifier": "0291162",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12346880",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR & INDUSTRIES",
            "identifier": "0353640",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Stevens Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Stevens, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.