Provider Demographics
NPI:1134514656
Name:MIDDENDORF CHIROPRACTIC PS
Entity type:Organization
Organization Name:MIDDENDORF CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-871-5200
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0525
Mailing Address - Country:US
Mailing Address - Phone:360-871-5200
Mailing Address - Fax:360-817-5350
Practice Address - Street 1:4255 SE MILE HILL DR
Practice Address - Street 2:# 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty