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NPI Code Detail

MEDICARE: NORTHWEST ADVANCED SPINAL CARE PLLC

MEDICARE: NORTHWEST ADVANCED SPINAL CARE PLLC
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
1111N00000XChiropractorCH60406528WA

General Provider Information

NPI Number : 1790212009
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST ADVANCED SPINAL CARE PLLC
Provider Business Mailing Address
First Line : PO BOX 1600
Second Line :
City : YELM
State : WA
Zip : 98597-1600
Country : US
Telephone Number : 360-400-3151
Fax Number : 360-400-3150
Provider Business Practice Location Address
First Line : 503 1ST ST S
Second Line :
City : YELM
State : WA
Zip : 98597-7634
Country : US
Telephone Number : 360-400-3151
Fax Number : 360-400-3150
Authorized Official
Title or Position : OWNER
Name : DR. MARK JOSEPH BINGEL
Credential : D.C.
Telephone Number : 360-400-3151
Provider Enumeration Date : 05/17/2017
Last Update Date : 09/12/2017

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Directions to “NORTHWEST ADVANCED SPINAL CARE PLLC ” Practice Location

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