NPIMap

Organization Active NPI

Olympic Spine and Sports Therapy PC

  • Chiropractor
  • Mountlake Terrace, WA
National Provider Identifier
1629250980
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00001890 Issued in WA
Legal business name
OLYMPIC SPINE AND SPORTS THERAPY PC
Practice address
6603 220TH St SW
Ste 102
Mountlake Terrace, WA 98043-2186
Phone
(425) 774-2411
Fax
(425) 672-7065
NPI assigned
Nov 28, 2007
Last updated
Mar 22, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Authorized official

Name
Lee Shelley
Title
Office Manager
Phone
(425) 774-2411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00001890 WA Primary

Addresses

Primary practice location

6603 220TH St SW
Ste 102
Mountlake Terrace, WA 98043-2186

Mailing address

6603 220TH St SW
Ste 102
Mountlake Terrace, WA 98043-2186
Phone (425) 774-2411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303001209 WA Part B Supplier - Clinic/Group Practice 7416844345 Receives reassigned benefits from 3 practitioners
Practice locations: Mountlake Terrace, WA

National Provider Directory

National Provider Directory

Locations

22019 Highway 99
Ste A
Edmonds, WA 98026
Phone (425) 697-6887

6603 220th St SW
Ste 102
Mountlake Terrace, WA 98043
Phone (425) 247-3231

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1629250980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6603 220TH ST SW",
            "address_2": "STE 102",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432186",
            "telephone_number": "425-774-2411",
            "fax_number": "425-672-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6603 220TH ST SW",
            "address_2": "STE 102",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432186",
            "telephone_number": "425-774-2411",
            "fax_number": "425-672-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC SPINE AND SPORTS THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "425-774-2411"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00001890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountlake Terrace, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.