NPIMap

Organization Active NPI

Evolve Wellness

  • Chiropractor
  • Portland, OR
National Provider Identifier
1033518709
Registry record updated Aug 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3123 Issued in OR
Legal business name
EVOLVE WELLNESS
Practice address
3125 E Burnside St
Portland, OR 97214-2073
Phone
(503) 758-9760
Fax
(503) 296-2554
NPI assigned
Aug 19, 2014
Last updated
Aug 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2014

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

Authorized official

Name
Kelly Barrett, DC
Title
Owner
Phone
(503) 939-8019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3123 OR Primary

Addresses

Primary practice location

3125 E Burnside St
Portland, OR 97214-2073

Mailing address

3125 E Burnside St
Portland, OR 97214-2073
Phone (503) 758-9760

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408406400000",
    "number": "1033518709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142073",
            "telephone_number": "503-758-9760",
            "fax_number": "503-296-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142073",
            "telephone_number": "503-758-9760",
            "fax_number": "503-296-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2014-08-19",
        "status": "A",
        "authorized_official_last_name": "BARRETT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-939-8019",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "3123",
            "primary": true
        }
    ],
    "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 Aug 19, 2014; 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.