NPIMap

Organization Active NPI

Eagle Harbor Chiropractic Inc.P.S.

  • Chiropractor
  • Bainbridge Island, WA
National Provider Identifier
1477684231
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3554 Issued in WA
Legal business name
EAGLE HARBOR CHIROPRACTIC INC.P.S.
Practice address
748 Winslow Way E
Bainbridge Island, WA 98110-2410
Phone
(206) 842-2702
NPI assigned
Mar 7, 2007
Last updated
Dec 5, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

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

Authorized official

Name
Kirk W Petheram, D.C.NPI 1770613580
Title
Owner
Phone
(206) 842-2702

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3554 WA Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 22433 CA
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3595 WA
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 22670 CA
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X MA00014485 WA
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X MA00019967 WA

Addresses

Primary practice location

748 Winslow Way E
Bainbridge Island, WA 98110-2410

Mailing address

748 Winslow Way E
Bainbridge Island, WA 98110-2410
Phone (206) 842-2702

National Provider Directory

National Provider Directory

Locations

181 Winslow Way E
Ste D
Bainbridge Island, WA 98110
Phone (206) 842-2702

748 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-2702

Practitioners & affiliated clinicians

Practitioners 11

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1477684231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 WINSLOW WAY E",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102410",
            "telephone_number": "206-842-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 WINSLOW WAY E",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102410",
            "telephone_number": "206-842-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE HARBOR CHIROPRACTIC INC.P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "PETHERAM",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-842-2702",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "3554",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "22433",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "3595",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "22670",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00014485",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00019967",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bainbridge Island, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.