MEDICARE: NORTHWEST PAIN RELIEF CENTERS LLC

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	261QM1300X	Multi-Specialty Clinic/Center	MD60359416	WA

General Provider Information

NPI Number	:	1356738694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PAIN RELIEF CENTERS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1190
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-1190
Country	:	US
Telephone Number	:	360-478-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	7424 BRIDGEPORT WAY W STE 305
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8135
Country	:	US
Telephone Number	:	253-472-9669
Fax Number	:	253-473-2904

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE BERGQUIST
Credential	:	D.C.
Telephone Number	:	360-362-0551

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	07/12/2016

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