MIDWAY HEALTHCARE THERAPEUTICS LLC (NPI# 1861031684) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861031684 |
| Entity Type | Organization |
| Organization Name | MIDWAY HEALTHCARE THERAPEUTICS LLC |
| Other Organization Name | FAIRWOOD CHIROPRACTIC CLINIC |
| Practice Address |
14410 Se Petrovitsky Rd Ste 109 Renton WA 98058-8900 |
| Practice Telephone | 4252261856 |
| Practice Fax Number | 4252260231 |
| Mailing Telephone | 4252261856 |
| Mailing Fax Number | 4252260231 |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | MR. TALLON NISHIHATA (GENERAL OPERATIONS) |
| Authorized Official Telephone | 2068249500 |
| Is Organization Subpart | Y |
| Parent Organization Name | MIDWAY HEALTHCARE THERAPEUTICS LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225700000X | Massage Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 171100000X | Acupuncturist | Other Service Providers | ||
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| Other Name | Type Code |
|---|---|
| FAIRWOOD CHIROPRACTIC CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861436420 | Midway Healthcare Therapeutics LLC | Chiropractor | 23100 Pacific Hwy S Ste 201, Des Moines, WA 98198-7281 | 2006-06-15 |
| Street Address |
14410 SE PETROVITSKY RD STE 109 |
| City | RENTON |
| State | WA |
| Zip Code | 98058-8900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376695486 | Steven T Ryan | Chiropractor | 14410 Se Petrovitsky Rd Ste 109, Renton, WA 98058-8900 | 2007-01-17 |
| 1750995551 | Alyssa Marie Baucom | Massage Therapist | 14410 Se Petrovitsky Rd Ste 109, Renton, WA 98058-8900 | 2020-08-31 |
| 1326220690 | Jasmine Ashley Adrian | Massage Therapist | 14410 Se Petrovitsky Rd Ste 109, Renton, WA 98058-8900 | 2007-11-28 |
| 1831370642 | Shannon Danelle Mcpherson | Massage Therapist | 14410 Se Petrovitsky Rd Ste 109, Renton, WA 98058-8900 | 2007-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639799471 | Fairwood Dental LLC | Dentist | 14250 Se 176th #j7, Renton, WA 98058 | 2020-04-22 |
| 1538641386 | Kenneth Graber | Physical Therapist | 17650 140th Avenue Sw, Suite B-07, Renton, WA 98058 | 2018-08-29 |
| 1508210154 | Lucy Johnson | Specialist/Technologist | 11808 Se 172nd Ln Apt N303, Renton, WA 98058 | 2016-04-20 |
| 1104253947 | Bertila Martinez | Dental Hygienist | 14600 Se 176th St #v4, Renton, WA 98058 | 2013-10-10 |
| 1326340456 | Tabatha Burris | Specialist | 14410 Petrovistsky Rd Se #109, Renton, WA 98058 | 2010-11-22 |
| 1295042570 | Hanh Q Nguyen | Pharmacist | 16940 116th Avenue Southeast, Renton, WA 98058 | 2010-09-08 |
| 1861692675 | Ernestine Johanna Rombouts | Counselor | 16205 128th Place Se, Renton, WA 98058 | 2007-07-19 |
| 1912100991 | Cara Rozell | Pharmacist | 400 South 43rd St, Renton, WA 98058 | 2007-06-07 |
| 1699821231 | Lynne Suzanne Balderson | Massage Therapist | 14410 Se Petrovitsky Rd #201, Renton, WA 98058 | 2007-01-26 |
| 1023173465 | Sara Jean Denherder | Massage Therapist | 17070 - 140th Ave Se, Renton, WA 98058 | 2006-12-26 |
| Find all providers in zip 98058 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679181952 | Shaka Hatcher | Chiropractor | 720 N 10th St Ste A-348, Renton, WA 98057-5683 | 2020-07-22 |
| 1851928535 | Marnie Hansen, Pllc | Chiropractor | 18122 W Lake Desire Dr Se, Renton, WA 98058-9526 | 2020-03-24 |
| 1952875817 | Kim's Chiropractic Clinic Inc | Chiropractor | 4509 Talbot Road South, Suite 104, Renton, WA 98055-5294 | 2019-01-14 |
| 1073095386 | Renton Spine Clinic | Chiropractor | 352 Sunset Blvd N, Renton, WA 98057-5514 | 2018-09-04 |
| 1275905721 | Todd R Glass | Chiropractor | 1024 N 10th Pl #2306, Renton, WA 98057 | 2015-10-23 |
| 1275917734 | Jade Chiropractic and Wellness Center | Chiropractor | 6003 Se 2nd St, Renton, WA 98059-8549 | 2015-07-15 |
| 1821397746 | Tae Yong Kim | Chiropractor | 819 South 3rd Street, Renton, WA 98057 | 2011-03-17 |
| 1083912760 | Dale D Nguyen | Chiropractor | 1222 Bronson Way N Ste 130, Renton, WA 98057-5727 | 2011-03-04 |
| 1700182995 | Samuel John Loosli | Chiropractor | 19201 108th Ave Se Ste 101, Renton, WA 98055-7379 | 2011-02-04 |
| 1063645463 | Matthew Olaf Jensen | Chiropractor | 801 S 3rd St Ste D, Renton, WA 98057-2799 | 2009-09-01 |
| Find all providers in RENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.