NPIMap

Organization Active NPI

K. C. Chiropractic LLC

Doing business as Stateline Chiropractic

  • Chiropractor
  • Milton Freewater, OR
National Provider Identifier
1104342567
Registry record updated Aug 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4101 Issued in OR
Legal business name
K. C. CHIROPRACTIC LLC
Doing business as
Stateline Chiropractic
Practice address
85458 Highway 11
Milton Freewater, OR 97862-7309
Phone
(541) 938-8300
Fax
(541) 938-3424
NPI assigned
Aug 17, 2017
Last updated
Aug 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2017

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

Authorized official

Name
Dr. Chad Edward Smith, D.C.NPI 1134411556
Title
Owner
Phone
(541) 938-8300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4101 OR Primary

Addresses

Primary practice location

85458 Highway 11
Milton Freewater, OR 97862-7309

Mailing address

85458 Highway 11
Milton Freewater, OR 97862-7309
Phone (541) 938-8300

Other names 1

  • Stateline Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211112002644 OR Part B Supplier - Clinic/Group Practice 6608265632 Receives reassigned benefits from 1 practitioner
Practice locations: Milton Freewater, OR

National Provider Directory

National Provider Directory

Locations

85458 Highway 11
Milton Frwtr, OR 97862
Phone (541) 938-8300

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502928000000",
    "number": "1104342567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85458 HIGHWAY 11",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978627309",
            "telephone_number": "541-938-8300",
            "fax_number": "541-938-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85458 HIGHWAY 11",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978627309",
            "telephone_number": "541-938-8300",
            "fax_number": "541-938-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K. C. CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "last_updated": "2017-08-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-938-8300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "4101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stateline Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milton Freewater, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2017; 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.