LIFESTREAMS CHIROPRACTIC CENTER, LLC (NPI# 1942588785) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942588785 |
| Entity Type | Organization |
| Organization Name | LIFESTREAMS CHIROPRACTIC CENTER, LLC |
| Other Organization Name | MARY ANN TACK, DC |
| Practice Address |
901 Brutscher St Ste 210 Newberg OR 97132-6094 |
| Practice Telephone | 5035372052 |
| Practice Fax Number | 5035388315 |
| Mailing Telephone | 5035372052 |
| Mailing Fax Number | 5035388315 |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2020-06-19 |
| Authorized Official Name | DR. MARY ANN TACK (CHIROPRACTOR/OWNER) |
| Authorized Official Telephone | 5035372052 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | 2863 | OR | Ambulatory Health Care Facilities |
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 274833 | 05 | |
| OR | MEDICARE ID TYPE UNSPECIFIED | 0000QGHFP | 01 |
| Other Name | Type Code |
|---|---|
| Mary Ann Tack, DC | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | LIFESTREAMS CHIROPRACTIC CENTER, LLC | 901 Brutscher St Ste 210, Newberg, OR 97132 |
| Street Address |
901 BRUTSCHER ST STE 210 |
| City | NEWBERG |
| State | OR |
| Zip Code | 97132-6094 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720692007 | Gabrielle Anastasia Humlie | Dietitian, Registered | 109 W 8th St, Newberg, OR 97132 | 2020-09-03 |
| 1093278111 | Viva Wheaton Psyd LLC | Clinical Neuropsychologist | 603 E. Hancock St, Newberg, OR 97132 | 2019-04-08 |
| 1255847554 | John Nguyen | Physical Therapy Assistant | 1900 E. Fulton St., Newberg, OR 97132 | 2017-12-21 |
| 1154835338 | Breanne Embrey | Pharmacist | 1001 Providence Dr., Newberg, OR 97132 | 2017-11-26 |
| 1174063473 | Patricia Roberts | Hearing Instrument Specialist | 1014 B N Springbrook Rd, Newberg, OR 97132 | 2017-03-06 |
| 1477906048 | Dr. Marsha A. Green, L.L.C. | Community/Behavioral Health | 710c Foothills Dr, Ste 104, Newberg, OR 97132 | 2016-07-19 |
| 1760841308 | George Fox University Physical Therapy Community Clinic | Physical Therapist | 501 Villa Road, Newberg, OR 97132 | 2016-02-10 |
| 1013321389 | Jaecelle Guadiz Galeniece | Family Medicine | 1003 Providence Dr Ste 110, Newberg, OR 97132 | 2014-06-16 |
| 1790116978 | Nancy Stiehler Thurston | Psychologist | 501 N. Villa Rd., Newberg, OR 97132 | 2013-12-12 |
| 1700138856 | Kristen Z. Grbavac O'halloran | Physical Therapist | 1515 Portland Road, Suite 102, Newberg, OR 97132 | 2012-10-12 |
| Find all providers in zip 97132 | ||||
| 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 |
|---|---|---|---|---|
| 1083133193 | Newberg Spine and Sport LLC | Chiropractor | 2504 Portland Rd Ste A, Newberg, OR 97132-1971 | 2017-09-11 |
| 1376088740 | Lesley Ann Hendricks | Chiropractor | 2505 E Portland Rd Ste 100, Newberg, OR 97132-1946 | 2016-12-21 |
| 1699015982 | Chad Moore | Chiropractor | 2504 Portland Rd, Ste A, Newberg, OR 97132-1971 | 2013-02-22 |
| 1841596236 | John Branden Garland | Chiropractor | 434 Villa Rd, Newberg, OR 97132-1855 | 2011-02-01 |
| 1760505713 | Terry Lee Stellflug | Chiropractor | 1556 E 1st, Newberg, OR 97132 | 2007-04-06 |
| 1346314135 | John J. Collins | Chiropractor | 420 Villa Rd, Newberg, OR 97132-1882 | 2006-11-20 |
| 1346347929 | Mary Ann Tack | Chiropractor | 901 Brutscher St, Ste 210, Newberg, OR 97132-6095 | 2006-09-17 |
| 1912018680 | Audrey Margareth Lusby | Chiropractor | 717 1/2 E First St, Newberg, OR 97132 | 2006-08-31 |
| 1316054711 | Julie E Mock | Chiropractor | 114 E Hancock St, Newberg, OR 97132-2822 | 2006-08-23 |
| 1841626025 | Lindsay Rae Carr | Chiropractor | 114 E Hancock St, Newberg, OR 97132-2822 | 2013-09-19 |
| Find all providers in NEWBERG | ||||
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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.