NPIMap

Organization Active NPI

MC3 Enterprises LLC

  • Chiropractor
  • Olympia, WA
National Provider Identifier
1740804830
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
MC3 ENTERPRISES LLC
Practice address
1822 Black Lake Blvd SW Ste 103
Olympia, WA 98512-5628
Phone
(615) 448-8562
NPI assigned
Jun 3, 2020
Last updated
Oct 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Authorized official

Name
Lisa McCulloughNPI 1568704195
Title
Coo
Phone
(360) 810-5201

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 Primary

Addresses

Primary practice location

1822 Black Lake Blvd SW Ste 103
Olympia, WA 98512-5628

Mailing address

1633 Summit Lake Shore Rd NW
Olympia, WA 98502-9437
Phone (360) 810-5201

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200720000873 WA Part B Supplier - Clinic/Group Practice 6800210253 Receives reassigned benefits from 1 practitioner
Practice locations: Olympia, WA

National Provider Directory

National Provider Directory

Locations

1822 Black Lake Blvd SW
Ste 103
Olympia, WA 98512
Phone (360) 943-0988

2103 Harrison Ave NW
#2644
Olympia, WA 98502

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1740804830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1633 SUMMIT LAKE SHORE RD NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985029437",
            "telephone_number": "360-810-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1822 BLACK LAKE BLVD SW STE 103",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985125628",
            "telephone_number": "615-448-8562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC3 ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-03",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "360-810-5201"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.