Provider Demographics
NPI:1609901545
Name:UNIVERSITY PLACE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:UNIVERSITY PLACE CHIROPRACTIC INC
Other - Org Name:UNIVERSITY PLACE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEU
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-566-2225
Mailing Address - Street 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4700
Mailing Address - Country:US
Mailing Address - Phone:253-566-2225
Mailing Address - Fax:
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 1D
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4700
Practice Address - Country:US
Practice Address - Phone:253-566-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003505111N00000X
WACH00034392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWI4950OtherREGENCE MATTHEU WILLIAMS
WA0187492OtherL&I THOMAS WILLIAMS
WA537922990OtherTHOMAS WILLIAMS DC TAX ID
WA117001OtherL&I MATTHEU WILLIAMS
WAWI4950OtherREGENCE MATTHEU WILLIAMS
WA537922990OtherTHOMAS WILLIAMS DC TAX ID
WAV00385Medicare UPIN
WA0187492OtherL&I THOMAS WILLIAMS