NPIMap

Organization Active NPI

Premier Care Wellness Company

Doing business as Premier Care Chiropractic

  • Chiropractor
  • Portland, OR
National Provider Identifier
1053012583
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PREMIER CARE WELLNESS COMPANY
Doing business as
Premier Care Chiropractic
Practice address
524 SE 14TH Ave
Portland, OR 97214-2428
Phone
(971) 544-7058
Fax
(971) 244-9058
NPI assigned
Mar 13, 2023
Last updated
Mar 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Authorized official

Name
Dr. Timothy Gallucci, DC
Title
Owner
Phone
(971) 544-7058

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary
Acupuncturist 171100000X NU
Massage Therapist 225700000X NU

Addresses

Primary practice location

524 SE 14TH Ave
Portland, OR 97214-2428

Mailing address

524 SE 14TH Ave
Portland, OR 97214-2428
Phone (971) 544-7058

Other names 1

  • Premier Care Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

524 SE 14th Ave
Portland, OR 97214
Phone (971) 544-7058

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": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1053012583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 SE 14TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142428",
            "telephone_number": "971-544-7058",
            "fax_number": "971-244-9058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 SE 14TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142428",
            "telephone_number": "971-544-7058",
            "fax_number": "971-244-9058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CARE WELLNESS COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "GALLUCCI",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-544-7058",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Care Chiropractic",
            "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 Mar 13, 2023; 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.