NPIMap

Organization Active NPI

Eagle Harbor Health & Chiropractic

  • Chiropractor
  • Olympia, WA
National Provider Identifier
1881964419
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00003554 Issued in WA
Legal business name
EAGLE HARBOR HEALTH & CHIROPRACTIC
Practice address
2405 Evergreen Park Dr SW Ste B1
Olympia, WA 98502-6000
Phone
(206) 842-2690
NPI assigned
Jan 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

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

Authorized official

Name
Dr. Kirk William Petheram, D.C.NPI 1770613580
Title
Owner
Phone
(206) 842-2702

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 CH00003554 WA Primary

Addresses

Primary practice location

2405 Evergreen Park Dr SW Ste B1
Olympia, WA 98502-6000

Mailing address

3212 Red Fern Dr NW
Olympia, WA 98502-3224
Phone (206) 842-2690

Other practice location 1

911 Hildebrand Ln NE Ste 102
Bainbridge Island, WA 98110-2824
Phone (120) 684-2269

Other practice location 2

271 Wyatt Way NE Ste 208
Bainbridge Island, WA 98110-2873
Phone (206) 842-2690

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120625000313 WA Part B Supplier - Clinic/Group Practice 8022273002 Receives reassigned benefits from 1 practitioner
Practice locations: Bainbridge Island, WA

National Provider Directory

National Provider Directory

Locations

911 Hildebrand Ln NE
Ste 102
Bainbridge Island, WA 98110
Phone (206) 842-2690

701 Winslow Way E
Ste A
Bainbridge Island, WA 98110

271 Wyatt Way NE
Ste 208
Bainbridge Island, WA 98110
Phone (206) 842-2690

931 Hildebrand Ln NE
#101A
Bainbridge Island, WA 98110

701 Winslow Way E
Ste B
Bainbridge Island, WA 98110
Phone (206) 842-2690

931 Hildebrand Ln NE
#101
Bainbridge Island, WA 98110
Phone (206) 842-2690

Practitioners & affiliated clinicians

Practitioners 9

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": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752192000000",
    "number": "1881964419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3212 RED FERN DR NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985023224",
            "telephone_number": "206-842-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 EVERGREEN PARK DR SW STE B1",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985026000",
            "telephone_number": "206-842-2690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Hildebrand Ln NE Ste 102",
            "address_purpose": "LOCATION",
            "city": "Bainbridge Island",
            "state": "WA",
            "postal_code": "981102824",
            "country_code": "US",
            "telephone_number": "120-684-2269",
            "fax_number": "206-842-2847",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "271 Wyatt Way NE Ste 208",
            "address_purpose": "LOCATION",
            "city": "Bainbridge Island",
            "state": "WA",
            "postal_code": "981102873",
            "country_code": "US",
            "telephone_number": "206-842-2690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAGLE HARBOR HEALTH & CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-12",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "PETHERAM",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-842-2702",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003554",
            "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 Jul 11, 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.