MEDICARE: DEGROOT CHIROPRACITC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002149	WA

General Provider Information

NPI Number	:	1306180021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEGROOT CHIROPRACITC

Provider Business Mailing Address
First Line	:	20536 108TH AVE SE
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-1542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20536 108TH AVE SE
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-1542
Country	:	US
Telephone Number	:	425-228-8355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINDA DEGROOT
Credential	:	DC
Telephone Number	:	425-228-8355

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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Directions to “DEGROOT CHIROPRACITC ” Practice Location

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