NPIMap

Organization Active NPI

Active Injury Rehab, LLC

  • Chiropractor
  • Portland, OR
National Provider Identifier
1003679200
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ACTIVE INJURY REHAB, LLC
Practice address
5253 NE Sandy Blvd
Portland, OR 97213-2562
Phone
(503) 766-4881
NPI assigned
Feb 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Keenan Borgardt, DCNPI 1346587227
Title
Owner
Phone
(503) 440-7470

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X

Addresses

Primary practice location

5253 NE Sandy Blvd
Portland, OR 97213-2562

Mailing address

1605 NE 51St Ave
Portland, OR 97213-2703
Phone (503) 440-7470

Other names 1

  • Cascade Spine & Injury Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1003679200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 NE 51ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132703",
            "telephone_number": "503-440-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5253 NE SANDY BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132562",
            "telephone_number": "503-766-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE INJURY REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "BORGARDT",
        "authorized_official_first_name": "KEENAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-440-7470",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Spine & Injury Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.