Provider Demographics
NPI:1366512337
Name:BMI DC PS
Entity type:Organization
Organization Name:BMI DC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELDERRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-338-1555
Mailing Address - Street 1:1700 132ND ST SE STE L
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5309
Mailing Address - Country:US
Mailing Address - Phone:425-338-1555
Mailing Address - Fax:425-338-0765
Practice Address - Street 1:1700 132ND ST SE STE C
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5309
Practice Address - Country:US
Practice Address - Phone:425-338-1555
Practice Address - Fax:425-338-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8854786Medicare PIN
WA8854784Medicare PIN