MIND & BODY WELLNESS OF BEAVERTON (NPI# 1588131411) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588131411 |
| Entity Type | Organization |
| Organization Name | MIND & BODY WELLNESS OF BEAVERTON |
| Practice Address |
4545 Sw Angel Ave Apt 108 Beaverton OR 97005-2717 |
| Practice Telephone | 5038911389 |
| Mailing Telephone | 5038911389 |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2018-10-29 |
| Authorized Official Name | DR. CHRISTOPHER KENT STEWART (CHIROPRACTIC PHYSICIAN) |
| Authorized Official Telephone | 5038911389 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | STATE CHIROPRACTIC LICENSE | 5857 | 01 |
| OR | LICENSE NUMBER | R4317 | 01 |
| OR | 500740983 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MIND & BODY WELLNESS OF BEAVERTON LLC | 4545 Sw Angel Ave, Suite 108, Beaverton, OR 97005 |
| Street Address |
4545 SW ANGEL AVE APT 108 |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-2717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| 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 |
|---|---|---|---|---|
| 1073113635 | Adam Hernandez | Chiropractor | 10208 Sw Conestoga Dr Apt 41, Beaverton, OR 97008-8416 | 2020-10-31 |
| 1053918193 | Evan Chin | Chiropractor | 3615 Sw Hall Blvd, Beaverton, OR 97005-2053 | 2020-10-01 |
| 1265904403 | Chirofit LLC | Chiropractor | 10700 Sw Beaverton Hillsdale Hwy Ste 211, Beaverton, OR 97005-3035 | 2018-12-28 |
| 1306312939 | Good Life Chiropractic LLC | Chiropractor | 1800 Nw 169th Pl Ste A310, Beaverton, OR 97006-7527 | 2018-10-22 |
| 1245716471 | Cassandra Hoy | Chiropractor | 10445 Sw Canyon Rd Ste 101, Beaverton, OR 97005-1938 | 2018-07-11 |
| 1831686427 | True Wellness Beaverton, LLC | Chiropractor | 6149 Sw Murray Blvd, Beaverton, OR 97008-4421 | 2018-04-18 |
| 1285144170 | Martin Petrovic | Chiropractor | 10700 Sw Beaverton Hillsdale Hwy Ste 622, Beaverton, OR 97005-3037 | 2017-10-04 |
| 1760930069 | Nathan D Cashion | Chiropractor | 15150 Sw Mallard Dr Unit 202, Beaverton, OR 97007-9368 | 2016-09-14 |
| 1679027098 | Paula Rivera | Chiropractor | 8196 Sw Hall Blvd Ste 106, Beaverton, OR 97008-4676 | 2016-08-15 |
| 1447601612 | Natural Balance Chiropractic Clinic, Inc. | Chiropractor | 7345 Sw 162nd Pl, Beaverton, OR 97007-6382 | 2016-06-28 |
| Find all providers in BEAVERTON | ||||
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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.