Organization Active NPI

Mukilteo Chiropractic Clinic, PLLC

  • Chiropractor
  • Mukilteo, WA
National Provider Identifier
1861628901
Registry record updated Jun 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3134 Issued in WA
Legal business name
MUKILTEO CHIROPRACTIC CLINIC, PLLC
Practice address
8004 Mukilteo Speedway Ste 1
Mukilteo, WA 98275-2653
Phone
(425) 353-1011
Fax
(425) 353-1033
NPI assigned
Jun 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2009

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

Authorized official

Name
Mr. Robert Steven Kreutz, DCNPI 1053319459
Title
Chiropractic
Phone
(425) 353-1011

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: 193200000X MULTI-SPECIALTY GROUP 111N00000X 3134 WA Primary

Addresses

Primary practice location

8004 Mukilteo Speedway Ste 1
Mukilteo, WA 98275-2653

Mailing address

8004 Mukilteo Speedway Ste 1
Mukilteo, WA 98275-2653
Phone (425) 353-1011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090716000436 WA Part B Supplier - Clinic/Group Practice 2264584507 Receives reassigned benefits from 1 practitioner
Practice locations: Lynnwood, WA

National Provider Directory

National Provider Directory

Locations

13624 Highway 99
Ste B4
Lynnwood, WA 98087
Phone (425) 353-1011

8004 Mukilteo Speedway
Mukilteo, WA 98275
Phone (425) 353-1011

8004 Mukilteo Speedway
Ste 1
Mukilteo, WA 98275
Phone (425) 353-1011

Practitioners & affiliated clinicians

Practitioners 4

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": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1861628901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8004 MUKILTEO SPEEDWAY STE 1",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982752653",
            "telephone_number": "425-353-1011",
            "fax_number": "425-353-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8004 MUKILTEO SPEEDWAY STE 1",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982752653",
            "telephone_number": "425-353-1011",
            "fax_number": "425-353-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUKILTEO CHIROPRACTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-03",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "KREUTZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "CHIROPRACTIC",
        "authorized_official_telephone_number": "425-353-1011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "3134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukilteo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; 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.