NPIMap

Organization Active NPI

Advanced Health Center, LLC

Doing business as Canby Spine & Sport

  • Chiropractor
  • Canby, OR
National Provider Identifier
1043491178
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
273072 Issued in OR
Legal business name
ADVANCED HEALTH CENTER, LLC
Doing business as
Canby Spine & Sport
Molalla Spine & Sport
Vissers Chiropractic
Practice address
130 SW 2ND Ave Ste 101
Canby, OR 97013-4156
Phone
(503) 263-3033
Fax
(503) 263-3023
NPI assigned
Nov 16, 2007
Last updated
Jun 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Dr. Michael Jay Vissers, D.C.NPI 1093843302
Title
President
Phone
(503) 263-3033

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 273072 OR Primary

Addresses

Primary practice location

130 SW 2ND Ave Ste 101
Canby, OR 97013-4156

Mailing address

130 SW 2ND Ave Ste 101
Canby, OR 97013-4156
Phone (503) 263-3033

Other practice location 1

317 N Molalla Ave
Molalla, OR 97038-8840
Phone (503) 829-6176

Other names 3

  • Canby Spine & Sport Doing business as
  • Molalla Spine & Sport Doing business as
  • Vissers Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101208001131 OR Part B Supplier - Clinic/Group Practice 1052508660 Receives reassigned benefits from 5 practitioners
Practice locations: Canby, OR; Molalla, OR

National Provider Directory

National Provider Directory

Locations

130 SW 2nd Ave
Ste 101
Canby, OR 97013
Phone (503) 263-2347

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1043491178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SW 2ND AVE STE 101",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970134156",
            "telephone_number": "503-263-3033",
            "fax_number": "503-263-3023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SW 2ND AVE STE 101",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970134156",
            "telephone_number": "503-263-3033",
            "fax_number": "503-263-3023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "317 N Molalla Ave",
            "address_purpose": "LOCATION",
            "city": "Molalla",
            "state": "OR",
            "postal_code": "970388840",
            "country_code": "US",
            "telephone_number": "503-829-6176",
            "fax_number": "503-829-6178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED HEALTH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "VISSERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-263-3033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "273072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canby Spine & Sport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Molalla Spine & Sport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vissers Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canby, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.