The Spark of Life Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

273520 Issued in OR

Legal business name

THE SPARK OF LIFE INC.

Practice address

9900 SW Wilshire St
Ste 170
Portland, OR 97225-5035

Phone

(503) 595-1717

Fax

(503) 595-1719

NPI assigned

Nov 7, 2007

Organization subpart

No

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

Authorized official

Name

Randall L. Fish, D.C.NPI 1265502702

Title

Owner/Ceo

Phone

(503) 595-1717

Specialties & licenses 1

Addresses

Practitioners 1

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

• Randall L Fish, DC

  • Chiropractor
  • Milwaukie, OR
  • NPI 1265502702
  NPD (past) Authorized official

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1083894034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 SW WILSHIRE ST",
            "address_2": "STE 170",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255035",
            "telephone_number": "503-595-1717",
            "fax_number": "503-595-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 SW WILSHIRE ST",
            "address_2": "STE 170",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255035",
            "telephone_number": "503-595-1717",
            "fax_number": "503-595-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPARK OF LIFE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "FISH",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "503-595-1717",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "273520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Aug 12, 2008; 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.