Active NPI
Carl Russell Botefuhr, DC
- Chiropractor
- Suquamish, WA
National Provider Identifier
1588860613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2461
- Practice address
- 6505 NE Prospect St
Suquamish, WA 98392-9702 - Phone
- (360) 509-7147
- NPI assigned
- Jun 25, 2007
- Last updated
- Nov 2, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2461 | WA | Primary |
Addresses
Primary practice location
6505 NE Prospect St
Suquamish, WA 98392-9702
Mailing address
PO Box 293
Suquamish, WA 98392-9702
Phone (360) 509-7147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2461 | WA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1588860613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 293",
"city": "SUQUAMISH",
"state": "WA",
"postal_code": "983929702",
"telephone_number": "360-509-7147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6505 NE PROSPECT ST",
"city": "SUQUAMISH",
"state": "WA",
"postal_code": "983929702",
"telephone_number": "360-509-7147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTEFUHR",
"first_name": "CARL",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-25",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "2461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suquamish, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.