NPIMap

Organization Active NPI

Lake Tapps Chiropractic Center, L.L.C.

  • Chiropractor
  • Bonney Lake, WA
National Provider Identifier
1679616569
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002318 Issued in WA
Legal business name
LAKE TAPPS CHIROPRACTIC CENTER, L.L.C.
Practice address
21157 State Route 410 E
Bonney Lake, WA 98391-8457
Phone
(253) 862-2138
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Daniel W Anderson, D.C.NPI 1760537021
Title
Owner
Phone
(253) 862-2138

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 SINGLE SPECIALTY GROUP 111N00000X CH00002318 WA Primary

Addresses

Primary practice location

21157 State Route 410 E
Bonney Lake, WA 98391-8457

Mailing address

PO Box 1549
Buckley, WA 98321-1549
Phone (253) 862-2138

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070522000010 WA Part B Supplier - Clinic/Group Practice 0840397113 Receives reassigned benefits from 2 practitioners
Practice locations: Bonney Lake, WA

National Provider Directory

National Provider Directory

Locations

21157 State Route 410 E
Bonney Lake, WA 98391
Phone (253) 862-2138

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679616569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1549",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983211549",
            "telephone_number": "253-862-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21157 STATE ROUTE 410 E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918457",
            "telephone_number": "253-862-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE TAPPS CHIROPRACTIC CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-862-2138",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.