NPIMap

Organization Active NPI

Derrick Family Chiropractic, Inc.

  • Chiropractor
  • Olympia, WA
National Provider Identifier
1891014411
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00003132 Issued in WA
Legal business name
DERRICK FAMILY CHIROPRACTIC, INC.
Practice address
3535 Martin Way E
Olympia, WA 98506-5049
Phone
(360) 438-6425
Fax
(360) 923-9382
NPI assigned
May 21, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Authorized official

Name
Dr. Mitchell Eugene Derrick, D.C.NPI 1265527154
Title
Chiropractor
Phone
(360) 438-6425

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: 193400000X SINGLE SPECIALTY GROUP 111N00000X CH00003132 WA Primary

Addresses

Primary practice location

3535 Martin Way E
Olympia, WA 98506-5049

Mailing address

3535 Martin Way E
Olympia, WA 98506-5049
Phone (360) 491-9135

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100724000010 WA Part B Supplier - Clinic/Group Practice 3577695683 Receives reassigned benefits from 2 practitioners
Practice locations: Lacey, WA

National Provider Directory

National Provider Directory

Locations

3535 Martin Way E
Olympia, WA 98506
Phone (360) 438-6425

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1274400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1891014411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065049",
            "telephone_number": "360-491-9135",
            "fax_number": "360-923-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065049",
            "telephone_number": "360-438-6425",
            "fax_number": "360-923-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK FAMILY CHIROPRACTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-21",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "360-438-6425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003132",
            "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 Apr 22, 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.