Individual provider Active NPI

Joel William Southwell, DC

  • Chiropractor
  • Issaquah, WA
National Provider Identifier
1619375482
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60505676 Issued in WA
Practice address
1525 NW Mall St
Issaquah, WA 98027-8947
Phone
(425) 800-6881
Fax
(425) 392-1039
NPI assigned
Dec 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH60505676 WA Primary

Addresses

Primary practice location

1525 NW Mall St
Issaquah, WA 98027-8947

Mailing address

1525 NW Mall St
Issaquah, WA 98027-8947
Phone (425) 800-6881

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH60505676WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Eastside Ideal Health Issaquah, PLLC Chiropractor CurrentSince Dec 22, 2020 Accepting new patients
JWSC PLLC Chiropractor CurrentSince Jun 23, 2024 Accepting new patients
Dech Chiropractor PastSince Apr 23, 2023 Accepting new patients
C&C Chiropractic Inc PS Chiropractor Past Accepting new patients

Locations

1525 NW Mall St
Issaquah, WA 98027
Phone (425) 800-6881

1275 12th Ave NW
Ste 1A
Issaquah, WA 98027
Phone (425) 444-4833

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1418169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1619375482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 NW MALL ST",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278947",
            "telephone_number": "425-800-6881",
            "fax_number": "425-392-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 NW MALL ST",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278947",
            "telephone_number": "425-800-6881",
            "fax_number": "425-392-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "JOEL",
        "middle_name": "WILLIAM",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-10",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60505676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.