NPIMap

Organization Active NPI

Neurosport Concussion and Spine

  • Chiropractor
  • Vancouver, WA
National Provider Identifier
1083454540
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
NEUROSPORT CONCUSSION AND SPINE
Practice address
1499 SE Tech Center PL Ste 350
Vancouver, WA 98683-9575
Phone
(360) 326-2121
NPI assigned
May 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Authorized official

Name
Alice L Grenier
Title
Office Manager
Phone
(360) 326-2121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X

Addresses

Primary practice location

1499 SE Tech Center PL Ste 350
Vancouver, WA 98683-9575

Mailing address

1499 SE Tech Center PL Ste 350
Vancouver, WA 98683-9575
Phone (360) 326-2121

Other names 1

  • NeuroSport Spine and Concussion Center Doing business as

National Provider Directory

National Provider Directory

Locations

1499 SE Tech Center Pl
Ste 350
Vancouver, WA 98683
Phone (360) 326-2121

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1083454540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 SE TECH CENTER PL STE 350",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839575",
            "telephone_number": "360-326-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 SE TECH CENTER PL STE 350",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839575",
            "telephone_number": "360-326-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSPORT CONCUSSION AND SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "GRENIER",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-326-2121"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NeuroSport Spine and Concussion Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.