Phoenix Rising Wellness Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PHOENIX RISING WELLNESS CENTER

Practice address

11008 Gravelly Lake Dr SW
Lakewood, WA 98499-1332

Phone

(253) 220-0711

Fax

(888) 317-8716

NPI assigned

Dec 9, 2020

Organization subpart

Yes

Parent organization

PHOENIX RISING WELLNESS CENTERAs reported in NPPES

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

Authorized official

Name

Dr. Shamika Cordis, DCNPI 1457642936

Title

Owner

Phone

(360) 728-0315

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Phoenix Rising Wellness Center of Lakewood Other name

Part of

Phoenix Rising Wellness Center

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Rising Phoenix Wellness Center, LLC

  • Clinical Social Worker
  • Coupeville, WA
  • NPI 1992261853
  NPPES parent name

Practitioners 1

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

• Shamika Cordis, D.C.

  • Chiropractor
  • Chicago, IL
  • NPI 1457642936
  NPD Authorized official

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1639775174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11008 GRAVELLY LAKE DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991332",
            "telephone_number": "253-220-0711",
            "fax_number": "888-317-8716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11008 GRAVELLY LAKE DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991332",
            "telephone_number": "253-220-0711",
            "fax_number": "888-317-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RISING WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX RISING WELLNESS CENTER",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "CORDIS",
        "authorized_official_first_name": "SHAMIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-728-0315",
        "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": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC",
            "identifier": "CH605050789",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Rising Wellness Center of Lakewood",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sarah Phenisee, PHARMD
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• Faith Harmony Philmlee
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• Pierce College
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• Khadeja Pierre

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.