NPIMap

Organization Active NPI

Redmond Back & Neck Care Clinic

  • Chiropractor
  • Redmond, WA
National Provider Identifier
1942855499
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
REDMOND BACK & NECK CARE CLINIC
Practice address
16440 NE 85TH St
Redmond, WA 98052-3613
Phone
(425) 885-9950
Fax
(425) 895-9766
NPI assigned
Aug 1, 2019
Last updated
Dec 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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

Authorized official

Name
Sharon T Wagener Dewolf, DCNPI 1245395276
Title
Provider/Owner
Phone
(425) 885-9950

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 Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X

Addresses

Primary practice location

16440 NE 85TH St
Redmond, WA 98052-3613

Mailing address

16440 NE 85TH St
Redmond, WA 98052-3613
Phone (425) 885-9950

Other names 1

  • Redmond Back & Neck Pain Clinic Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210607001655 WA Part B Supplier - Clinic/Group Practice 5698175016 Receives reassigned benefits from 1 practitioner
Practice locations: Redmond, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1564617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1942855499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16440 NE 85TH ST",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980523613",
            "telephone_number": "425-885-9950",
            "fax_number": "425-895-9766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16440 NE 85TH ST",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980523613",
            "telephone_number": "425-885-9950",
            "fax_number": "425-895-9766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDMOND BACK & NECK CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-01",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "WAGENER DEWOLF",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "425-885-9950",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redmond Back & Neck Pain Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Redmond Back & Neck Pain Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Redmond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.