Individual provider Active NPI

Kohl Clark Marks, DC

  • Chiropractor
  • Eugene, OR
National Provider Identifier
1023585593
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5942 Issued in OR
Practice address
1400 Executive Pkwy
Eugene, OR 97401-6712
Phone
(541) 345-1669
Fax
(541) 359-2238
NPI assigned
Nov 1, 2018
Last updated
Apr 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5942 OR Primary

Addresses

Primary practice location

1400 Executive Pkwy
Eugene, OR 97401-6712

Mailing address

1400 Executive Pkwy Ste 220
Eugene, OR 97401-7109
Phone (541) 345-1669

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200123001610 OR Practitioner - Chiropractic 9234564147 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1200 Executive Pkwy
Suite 340
Eugene, OR 97401-2169
Phone (541) 345-1669

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5942ORMDVeterinarian

Practice roles

OrganizationSpecialtyStatusNew patients
Marks Family Chiropractic LLC Chiropractor CurrentSince Jan 1, 2022 Accepting new patients
Flexfit Chiropractic, LLC Chiropractor PastSince Dec 13, 2019 Accepting new patients

Locations

1400 Executive Pkwy
Ste 220
Eugene, OR 97401
Phone (541) 345-1669

Networks

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

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1023585593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 EXECUTIVE PKWY STE 220",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974017109",
            "telephone_number": "541-345-1669",
            "fax_number": "541-359-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EXECUTIVE PKWY",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974016712",
            "telephone_number": "541-345-1669",
            "fax_number": "541-359-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKS",
        "first_name": "KOHL",
        "middle_name": "CLARK",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-01",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; 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.