Chiropractic Injury Center, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

CHIROPRACTIC INJURY CENTER, LLC

Practice address

11679 NE Glisan St
Portland, OR 97220-2264

Phone

(971) 373-8257

Fax

(971) 373-8259

NPI assigned

Mar 25, 2019

Last updated

Mar 25, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dmitriy V TupikovNPI 1316392814

Title

Owner

Phone

(971) 373-8257

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

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.

• Dmitriy Tupikov, D.C.

  • Chiropractor
  • Portland, OR
  • NPI 1316392814
  Authorized official Same address or phone

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553472000000",
    "number": "1073073904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11679 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972202264",
            "telephone_number": "971-373-8257",
            "fax_number": "971-373-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11679 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972202264",
            "telephone_number": "971-373-8257",
            "fax_number": "971-373-8259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC INJURY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-25",
        "last_updated": "2019-03-25",
        "status": "A",
        "authorized_official_last_name": "TUPIKOV",
        "authorized_official_first_name": "DMITRIY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-373-8257"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500742574",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractic Physicians and Rehabilitation, PC
• Chirotime, P.C.
• Yevhen Chishko Chishko

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.