CHIROPRACTIC INJURY CENTER, LLC (NPI# 1073073904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073073904 |
| Entity Type | Organization |
| Organization Name | CHIROPRACTIC INJURY CENTER, LLC |
| Practice Address |
11679 Ne Glisan St Portland OR 97220-2264 |
| Practice Telephone | 9713738257 |
| Practice Fax Number | 9713738259 |
| Mailing Telephone | 9713738257 |
| Mailing Fax Number | 9713738259 |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2019-03-25 |
| Authorized Official Name | DMITRIY V TUPIKOV (OWNER) |
| Authorized Official Telephone | 9713738257 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500742574 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932264900 | Chiropractic Injury Center, LLC | Chiropractor | 199 Shirley Ave, Revere, MA 02151-3258 | 2006-12-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | CHIROPRACTIC INJURY CENTER, LLC | 11679 Ne Glisan St, Portland, OR 97220 |
| Massachusetts Corporations | CHIROPRACTIC INJURY CENTER, LLC | 199 Shirley Ave., Revere, MA 02151 |
| Street Address |
11679 NE GLISAN ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97220-2264 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467509679 | Benjamin Lee Heath | Chiropractor | 11679 Ne Glisan St, Portland, OR 97220-2264 | 2007-01-03 |
| 1316392814 | Dmitriy Tupikov | Chiropractor | 11679 Ne Glisan St, Portland, OR 97220-2264 | 2016-05-03 |
| 1932230950 | Alfred Peter | Chiropractor | 11679 Ne Glisan St, Portland, OR 97220-2264 | 2007-03-08 |
| 1679613442 | Lee Nmi Mccaffrey | Chiropractor | 11679 Ne Glisan St, Portland, OR 97220-2264 | 2007-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316569254 | Debra Shamblin | Behavioral Analyst | 150 Ne 100th Ave, Portland, OR 97220 | 2020-05-14 |
| 1336780618 | Joan Lambert | Technician | 2802 Ne 108th Avenue, Portland, OR 97220 | 2019-10-08 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1194223107 | Landmark Connect of Oregon PC | General Practice | 5933 Ne Win Sivers Dr Ste 310, Portland, OR 97220 | 2018-01-24 |
| 1487178711 | Andrew Shonk | Massage Therapist | 163 Ne 102nd Ave Blid V, Portland, OR 97220 | 2017-07-28 |
| 1548781693 | Greater New Hope Family Services | Lodging | 11868 Ne Sandy Blvd, Portland, OR 97220 | 2017-06-29 |
| 1245771740 | Maria Teresa Banez Salcedo | Registered Nurse | 10300 Ne Hancock Street, Portland, OR 97220 | 2017-03-16 |
| 1568901858 | Christopher Gabriel Lyons | Adult Companion | 1343 Ne 118 Ave. Apt5, Portland, OR 97220 | 2017-02-20 |
| 1962945956 | Linda Ann Oldenburg | Registered Nurse | 9515 Ne Skidmore Avenue, Portland, OR 97220 | 2016-11-23 |
| 1326493446 | Trent D. Wilson | Massage Therapist | 8401 Ne Halsey St., Suite 101, Portland, OR 97220 | 2016-04-26 |
| Find all providers in zip 97220 | ||||
| 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 |
|---|---|---|---|---|
| 1700486958 | Amy Elizabeth Goebel | Chiropractor | 5103 Se Stark St Apt B, Portland, OR 97215-1764 | 2020-10-27 |
| 1003423914 | Evergreen Chiropractic PC | Chiropractor | 7145 Sw Varns St Ste 203, Portland, OR 97223-8168 | 2020-09-24 |
| 1750993283 | University of Western States Healthcare Inc | Chiropractor | 8000 Ne Tillamook St, Portland, OR 97213-6655 | 2020-08-17 |
| 1518587989 | Kristy Pearl Arneson | Chiropractor | 3715 Se Cesar E Chavez Blvd, Portland, OR 97202-1704 | 2020-04-25 |
| 1770102956 | Behireta Corbadzic | Chiropractor | 12923 Se Foster Rd Unit G703, Portland, OR 97236-4702 | 2020-04-08 |
| 1134754427 | Bonnie Anderson | Chiropractor | 3539 N Williams Ave Ste 202a, Portland, OR 97227-1437 | 2020-03-06 |
| 1629601372 | Megan Adele Robles | Chiropractor | 2100 Ne Broadway St Ste 255, Portland, OR 97232-1544 | 2020-02-20 |
| 1306479472 | Naomi M Enos-burles | Chiropractor | 7332 Sw 13th Dr Apt A, Portland, OR 97219-2089 | 2020-02-18 |
| 1184256927 | Michael Nicosia | Chiropractor | 207 Santa Monica St, Portland, TX 78374-2645 | 2020-02-10 |
| 1942832258 | Tracy Yvonne Still | Chiropractor | 3905b Ne Grand Ave Unit B, Portland, OR 97212-1107 | 2020-02-05 |
| Find all providers in PORTLAND | ||||
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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.