NPIMap

Individual provider Active NPI

Robert Provasoli, D.C.

  • Chiropractor
  • Olympia, WA
National Provider Identifier
1891861001
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002232 Issued in WA
Practice address
1018 7TH Ave SE
Olympia, WA 98501-1512
Phone
(360) 459-8114
Fax
(360) 493-8742
NPI assigned
Nov 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00002232 WA Primary

Addresses

Primary practice location

1018 7TH Ave SE
Olympia, WA 98501-1512

Mailing address

1018 7TH Ave SE
Olympia, WA 98501-1512
Phone (360) 459-8114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CH00002232WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Provasoli Chiropractic Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891861001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 7TH AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011512",
            "telephone_number": "360-459-8114",
            "fax_number": "360-493-8742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 7TH AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011512",
            "telephone_number": "360-459-8114",
            "fax_number": "360-493-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVASOLI",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002232",
            "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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.