Jennie-Marie Evanka Archambault, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5923 Issued in OR

Practice address

3990 Collins Way
Lake Oswego, OR 97035

Phone

(503) 635-1236

NPI assigned

Aug 29, 2018

Last updated

Sep 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kruse Park Chiropractic LLCGroup PAC ID 9032453568, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

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

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.

• Kruse Park Chiropractic LLC

  • Chiropractor
  • Lake Oswego, OR
  • NPI 1700363389
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1043792856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 COLLINS WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353480",
            "telephone_number": "503-805-9680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 COLLINS WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "503-635-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHAMBAULT",
        "first_name": "JENNIE-MARIE",
        "middle_name": "EVANKA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-29",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Anest
• Concetta Marie Antonelli, L.M.T.
• Debra R Applebaum, PHD
• Apricity Counseling & Consultation, LLC
• Samantha Arcediano, PA-C
• Valencia Arciniega, LMT
• Armworks Hand Therapy, LLC
• Celeste Arnold
• Julieta Arredondo, FNP
• Patrick Andrew Arville, PT

• Chiropractor in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; 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.