Provider Demographics
NPI:1962852038
Name:NORTHWEST PAIN RELIEF CENTERS, LLC
Entity Type:Organization
Organization Name:NORTHWEST PAIN RELIEF CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-713-4721
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 W FIR ST
Practice Address - Street 2:SUITE D
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3210
Practice Address - Country:US
Practice Address - Phone:360-797-1728
Practice Address - Fax:360-797-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8948554Medicare PIN