Provider Demographics
NPI:1235590522
Name:REDMOND CHIROPRACTIC & MASSAGE, PS
Entity Type:Organization
Organization Name:REDMOND CHIROPRACTIC & MASSAGE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:GOLDEN
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-822-4326
Mailing Address - Street 1:8299 161ST AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3860
Mailing Address - Country:US
Mailing Address - Phone:425-881-7790
Mailing Address - Fax:425-558-5676
Practice Address - Street 1:6515 132ND AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8628
Practice Address - Country:US
Practice Address - Phone:425-822-4326
Practice Address - Fax:425-827-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8899265Medicare UPIN