Provider Demographics
NPI:1659312049
Name:MIDDENDORF, JOYCE K (DC)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:K
Last Name:MIDDENDORF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 SE MILE HILL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3920
Mailing Address - Country:US
Mailing Address - Phone:360-871-5200
Mailing Address - Fax:360-871-5350
Practice Address - Street 1:4255 SE MILE HILL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3920
Practice Address - Country:US
Practice Address - Phone:360-871-5200
Practice Address - Fax:360-871-5350
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH1707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB18075Medicare ID - Type UnspecifiedMEDICARE
WAT02181Medicare UPIN