Provider Demographics
NPI:1073666780
Name:MILE HILL CHIROPRACTIC
Entity Type:Organization
Organization Name:MILE HILL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MIDDENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-871-5200
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0525
Mailing Address - Country:US
Mailing Address - Phone:360-871-5200
Mailing Address - Fax:360-871-5350
Practice Address - Street 1:4519 SE MILE HILL DR STE A
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3909
Practice Address - Country:US
Practice Address - Phone:360-871-5200
Practice Address - Fax:360-871-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA66982OtherDR JOYCE LABOR INDUSTRIES
WA138013OtherLMP CINDY LI
WA0152874OtherLMP AMANDA LI
WA0169804OtherLMP ARIN LI
WA60732OtherDR DAVES LABOR INDUSTRIE
WAT02180Medicare UPIN
WAAB18076Medicare ID - Type UnspecifiedDR DAVES MEDICARE
WA138013OtherLMP CINDY LI
WAAB18075Medicare ID - Type UnspecifiedDR JOYCES MEDICARE