NPIMap

Organization Active NPI

MKG Full Moon Inc

  • Chiropractor
  • Seattle, WA
National Provider Identifier
1710119102
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00003354 Issued in WA
Legal business name
MKG FULL MOON INC
Doing business as
Core Chiropractic & Wellness
Practice address
2611 NE 125TH St
Suite 240
Seattle, WA 98125-4373
Phone
(206) 708-7172
Fax
(206) 913-2568
NPI assigned
Aug 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2011

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

Authorized official

Name
Dr. Daniel Buquicchio, D.C.
Title
Ceo
Phone
(206) 708-7172

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH00003354 WA Primary

Addresses

Primary practice location

2611 NE 125TH St
Suite 240
Seattle, WA 98125-4373

Mailing address

2611 NE 125TH St
Suite 240
Seattle, WA 98125-4373
Phone (206) 708-7172

Other names 1

  • Core Chiropractic & Wellness Doing business as

National Provider Directory

National Provider Directory

Locations

2611 NE 125th St
Ste 240
Seattle, WA 98125
Phone (206) 708-7172

NPI Registry JSON

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1710119102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 NE 125TH ST",
            "address_2": "SUITE 240",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981254373",
            "telephone_number": "206-708-7172",
            "fax_number": "206-913-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 NE 125TH ST",
            "address_2": "SUITE 240",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981254373",
            "telephone_number": "206-708-7172",
            "fax_number": "206-913-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MKG FULL MOON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-18",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "BUQUICCHIO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-708-7172",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Core Chiropractic & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.