Individual provider Active NPI

Daniel Antonio Lujan, D.C.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1003132408
Registry record updated Apr 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4013 Issued in OR
Practice address
4425 SW Corbett Ave
Portland, OR 97239-4260
Phone
(503) 225-9033
Fax
(503) 225-9039
NPI assigned
Apr 12, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4013 OR Primary
Neurology Chiropractor 111NN0400X 4013 OR
Nutrition Chiropractor 111NN1001X 4013 OR
Pediatric Chiropractor 111NP0017X 4013 OR
Radiology Chiropractor 111NR0200X 4013 OR
Rehabilitation Chiropractor 111NR0400X 4013 OR
Sports Physician Chiropractor 111NS0005X 4013 OR
Orthopedic Chiropractor 111NX0800X 4013 OR

Addresses

Primary practice location

4425 SW Corbett Ave
Portland, OR 97239-4260

Mailing address

4425 SW Corbett Ave
Portland, OR 97239-4260
Phone (503) 225-9033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120207000666 OR Practitioner - Chiropractic 1456518513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

19300 SW Boones Ferry Rd
Suite 12
Tualatin, OR 97062-9062
Phone (503) 692-6568

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4013ORMDNutrition Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Tree City Chiropractic P.C. Rehabilitation CurrentSince Sep 16, 2011 Accepting new patients

Locations

19300 SW Boones Ferry Rd
Ste 12
Tualatin, OR 97062
Phone (503) 692-6568

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271030400000",
    "number": "1003132408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 SW CORBETT AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394260",
            "telephone_number": "503-225-9033",
            "fax_number": "503-225-9039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 SW CORBETT AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394260",
            "telephone_number": "503-225-9033",
            "fax_number": "503-225-9039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUJAN",
        "first_name": "DANIEL",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-12",
        "last_updated": "2010-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "4013",
            "primary": true
        },
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "OR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "OR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "OR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "111NR0200X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Radiology",
            "state": "OR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "OR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "OR",
            "license": "4013",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.