Kelsall Chiropractic Clinic PC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

2997 Issued in OR

Legal business name

KELSALL CHIROPRACTIC CLINIC PC

Practice address

1615 NW 23Rd Ave
Suite 2
Portland, OR 97210-2563

Phone

(503) 223-8719

Fax

(503) 223-3237

NPI assigned

Jun 26, 2008

Organization subpart

No

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

Authorized official

Name

Amy Burgess, OFFICE MANAGER

Title

Office Manager

Phone

(503) 223-8719

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karen B Kelsall, D.C.

  • Sports Physician Chiropractor
  • Portland, OR
  • NPI 1801844568
  Medicare reassignment Care Compare group NPD
• Shelby N Tweto, DC

  • Chiropractor
  • Portland, OR
  • NPI 1790739043
  Medicare reassignment Care Compare group NPD
• Sarah E Stanton, LMT, CA

  • Massage Therapist
  • Portland, OR
  • NPI 1790356715
  NPD

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1063674679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 NW 23RD AVE",
            "address_2": "SUITE 2",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102563",
            "telephone_number": "503-223-8719",
            "fax_number": "503-223-3237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 NW 23RD AVE",
            "address_2": "SUITE 2",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102563",
            "telephone_number": "503-223-8719",
            "fax_number": "503-223-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELSALL CHIROPRACTIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-223-8719",
        "authorized_official_credential": "OFFICE MANAGER"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "2997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER ID",
            "identifier": "R100924",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shay Juniper Kelly, PH.D.
• Stephen P Kelly, MD
• Suzanne Kelly, RN
• Timothy Kelly
• Toneasha Kelly
• Karen B Kelsall, D.C.
• Aaron Michael Kelsay
• Carisha Justine Kelsey, PHD
• Peter Kelsey
• Daniel Kelso, PHARMD

• Sports Physician Chiropractor in Portland, OR
• Providers in Portland, OR by specialty
• Sports Physician Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.