NPIMap

Organization Active NPI

Peninsula Chiropractic Clinic

  • Chiropractor
  • Port Hadlock, WA
National Provider Identifier
1861794182
Registry record updated Feb 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00034364 Issued in WA
Legal business name
PENINSULA CHIROPRACTIC CLINIC
Practice address
231 W Patison St
Port Hadlock, WA 98339-9751
Phone
(360) 385-4900
Fax
(360) 385-3798
NPI assigned
Nov 18, 2010
Last updated
Feb 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2011

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

Authorized official

Name
Dr. Michael Dam, D.C.NPI 1588602742
Title
President
Phone
(360) 385-4900

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH00034364 WA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X AP30005953 WA

Addresses

Primary practice location

231 W Patison St
Port Hadlock, WA 98339-9751

Mailing address

231 W Patison St
Port Hadlock, WA 98339-9751

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110224000957 WA Part B Supplier - Clinic/Group Practice 7810177219 Receives reassigned benefits from 2 practitioners
Practice locations: Port Hadlock, WA

National Provider Directory

National Provider Directory

Locations

231 W Patison St
Port Hadlock, WA 98339
Phone (360) 385-4900

Practitioners & affiliated clinicians

Practitioners 8

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": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1861794182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 W PATISON ST",
            "city": "PORT HADLOCK",
            "state": "WA",
            "postal_code": "983399751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 W PATISON ST",
            "city": "PORT HADLOCK",
            "state": "WA",
            "postal_code": "983399751",
            "telephone_number": "360-385-4900",
            "fax_number": "360-385-3798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-18",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "DAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-385-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034364",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30005953",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Hadlock, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; 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.