Kirk W Petheram, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3554 Issued in WA

Practice address

701 Winslow Way E Ste B
Bainbridge Island, WA 98110-2416

Phone

(206) 842-2702

NPI assigned

Mar 7, 2007

Last updated

Jan 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eagle Harbor Health & Chiropractic

  • Chiropractor
  • Olympia, WA
  • NPI 1881964419
  Medicare reassignment NPD Authorized official
• Eagle Harbor Chiropractic Inc.P.S.

  • Chiropractor
  • Bainbridge Island, WA
  • NPI 1477684231
  NPD (past) Authorized official

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326326400000",
    "number": "1770613580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 WINSLOW WAY E STE B",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102416",
            "telephone_number": "206-842-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 WINSLOW WAY E STE B",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102416",
            "telephone_number": "206-842-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETHERAM",
        "first_name": "KIRK",
        "middle_name": "W",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2012-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "3554",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "22433",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Robert Pentek, D.P.M.
• Personal Growth Productions, LLC
• Peter Lucas, PLLC
• Judith Ann Peters, PH.D.
• Trina Ann Peterson, RN
• Teresa Piddington, LMP
• Robert Thomas Platt, MD
• Simon Potter, L.AC
• Francine Hay Powel, PH.D.
• Frances Ann Powell, MA, LMFT

• Chiropractor in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.