NPIMap

Organization Active NPI

Dynamic Chiropractic Clinic, PS

  • Chiropractor
  • Kenmore, WA
National Provider Identifier
1609045004
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH33993 Issued in WA
Legal business name
DYNAMIC CHIROPRACTIC CLINIC, PS
Practice address
17511 68TH Ave NE
Suite 1
Kenmore, WA 98028
Phone
(206) 343-3325
Fax
(206) 838-7330
NPI assigned
Feb 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Dr. Peter Keith Carr, D.C.NPI 1033193164
Title
President
Phone
(206) 343-3325

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
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH33993 WA Primary

Addresses

Primary practice location

17511 68TH Ave NE
Suite 1
Kenmore, WA 98028

Mailing address

17511 68TH Ave NE
Suite 1
Kenmore, WA 98028
Phone (206) 343-3325

National Provider Directory

National Provider Directory

Locations

17511 68th Ave NE
Ste 1
Kenmore, WA 98028
Phone (206) 343-3325

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1609045004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17511 68TH AVE NE",
            "address_2": "SUITE 1",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "98028",
            "telephone_number": "206-343-3325",
            "fax_number": "206-838-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17511 68TH AVE NE",
            "address_2": "SUITE 1",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "98028",
            "telephone_number": "206-343-3325",
            "fax_number": "206-838-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC CHIROPRACTIC CLINIC, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-29",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-343-3325",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH33993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenmore, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.