Puyallup Wellness PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PUYALLUP WELLNESS PLLC

Practice address

2802 S Meridian
Puyallup, WA 98373-1402

Phone

(253) 445-5032

Fax

(253) 845-0129

NPI assigned

Nov 12, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Bradley Mundt, DC

Title

Clinic Director

Phone

(253) 473-3733

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Active Chiropractic & Massage Doing business as

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1639714850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 S MERIDIAN",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983731402",
            "telephone_number": "253-445-5032",
            "fax_number": "253-845-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 S MERIDIAN",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983731402",
            "telephone_number": "253-445-5032",
            "fax_number": "253-845-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "MUNDT",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "253-473-3733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G8945973",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Chiropractic & Massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Puyallup Valley Physical Therapy, Inc. P. S.
• Puyallup Valley St. Francis House
• Puyallup Valley Women'S Clinic, Inc.,P.S.
• Puyallup Vision Center PS
• Puyallup Wellness Center
• William Raymond Pyle, PTA
• QCTS, Inc.
• Erin Melissa Quann, RN, LMP
• Quest Diagnostics Clinical Laboratories Inc
• Donna R Quiles, CRT

• Chiropractor in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.