Individual provider Active NPI

Gina Eilertson, D.C.

  • Chiropractor
  • Shady Cove, OR
National Provider Identifier
1093268286
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5728 Issued in OR
Practice address
21885 Highway 62
Shady Cove, OR 97539-9418
Phone
(541) 878-3603
Fax
(541) 538-5503
NPI assigned
Jul 25, 2016
Last updated
May 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5728 OR Primary

Addresses

Primary practice location

21885 Highway 62
Shady Cove, OR 97539-9418

Mailing address

1744 E McAndrews Rd Ste D
Medford, OR 97504-5576
Phone (541) 414-0362

Other identifiers 1

IdentifierTypeStateIssuer
500787304MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160926000878 OR Practitioner - Chiropractic 4385931963 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shady Cove Chiropractic LLCGroup PAC ID 5597156638, 2 clinicians

Practice addresses (Care Compare)

21885 Hwy 62
Shady Cove, OR 97539-8715
Phone (541) 878-3603

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5728ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shady Cove Chiropractic, LLC Chiropractor CurrentSince Dec 8, 2021 Accepting new patients
Southern Oregon Chiropractic, LLC Chiropractor CurrentSince Jan 1, 2021 Accepting new patients

Locations

1744 E McAndrews Rd
Ste D
Medford, OR 97504

2931 Doctors Park Dr
Medford, OR 97504
Phone (541) 245-4444

21885 Highway 62
Shady Cove, OR 97539
Phone (541) 878-3603

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1093268286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 E MCANDREWS RD STE D",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045576",
            "telephone_number": "541-414-0362",
            "fax_number": "541-200-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21885 HIGHWAY 62",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "975399418",
            "telephone_number": "541-878-3603",
            "fax_number": "541-538-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EILERTSON",
        "first_name": "GINA",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-25",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500787304",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shady Cove, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.