Provider Demographics
NPI:1790212009
Name:NORTHWEST ADVANCED SPINAL CARE PLLC
Entity Type:Organization
Organization Name:NORTHWEST ADVANCED SPINAL CARE PLLC
Other - Org Name:NORTHWEST ADVANCED SPINAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BINGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-400-3151
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1600
Mailing Address - Country:US
Mailing Address - Phone:360-400-3151
Mailing Address - Fax:360-400-3150
Practice Address - Street 1:503 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7634
Practice Address - Country:US
Practice Address - Phone:360-400-3151
Practice Address - Fax:360-400-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60406528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty