NPIMap

Organization Active NPI

Midway Healthcare Therapeutics LLC

  • Chiropractor
  • Renton, WA
National Provider Identifier
1861031684
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
MIDWAY HEALTHCARE THERAPEUTICS LLC
Practice address
14410 SE Petrovitsky Rd Ste 109
Renton, WA 98058-8900
Phone
(425) 226-1856
Fax
(425) 226-0231
NPI assigned
Dec 26, 2019
Organization subpart
Yes
Parent organization
MIDWAY HEALTHCARE THERAPEUTICS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Authorized official

Name
Mr. Tallon Nishihata
Title
General Operations
Phone
(206) 824-9500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X

Addresses

Primary practice location

14410 SE Petrovitsky Rd Ste 109
Renton, WA 98058-8900

Mailing address

14410 SE Petrovitsky Rd Ste 109
Renton, WA 98058-8900
Phone (425) 226-1856

Other names 1

  • FAIRWOOD CHIROPRACTIC CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040622000635 WA Part B Supplier - Clinic/Group Practice 9638154826 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Des Moines, WA; Renton, WA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Fairwood Chiropractic Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23100 Pacific Hwy S
Ste 201
Des Moines, WA 98198
Phone (206) 824-9500

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 6

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": "1577318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1861031684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14410 SE PETROVITSKY RD STE 109",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980588900",
            "telephone_number": "425-226-1856",
            "fax_number": "425-226-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14410 SE PETROVITSKY RD STE 109",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980588900",
            "telephone_number": "425-226-1856",
            "fax_number": "425-226-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY HEALTHCARE THERAPEUTICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWAY HEALTHCARE THERAPEUTICS LLC",
        "enumeration_date": "2019-12-26",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "NISHIHATA",
        "authorized_official_first_name": "TALLON",
        "authorized_official_title_or_position": "GENERAL OPERATIONS",
        "authorized_official_telephone_number": "206-824-9500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAIRWOOD CHIROPRACTIC CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAIRWOOD CHIROPRACTIC CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.