=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497214399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NW MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2019
-----------------------------------------------------
Last Update Date | 11/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 MAIN AVE S STE 205
-----------------------------------------------------
City | NORTH BEND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98045-8197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-954-6538
-----------------------------------------------------
Fax | 425-880-3983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 MAIN AVE S STE 205
-----------------------------------------------------
City | NORTH BEND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98045-8197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-954-6538
-----------------------------------------------------
Fax | 425-880-3983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MATTHEW J DUNN
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 425-954-6538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------