Provider Demographics
NPI:1598836363
Name:NEWPORT CHIROPRACTIC CENTER, PS.
Entity Type:Organization
Organization Name:NEWPORT CHIROPRACTIC CENTER, PS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LORGE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:425-747-5657
Mailing Address - Street 1:4307 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1936
Mailing Address - Country:US
Mailing Address - Phone:425-747-5657
Mailing Address - Fax:425-747-5334
Practice Address - Street 1:4307 FACTORIA BLVD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1936
Practice Address - Country:US
Practice Address - Phone:425-747-5657
Practice Address - Fax:425-747-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID NUMBER