Individual provider Active NPI

Glenn Sykes, D.C.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1104994581
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
27 2964 Issued in OR
Practice address
7715 SE Grant St
Portland, OR 97215-4116
Phone
(503) 774-4418
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 27 2964 OR Primary

Addresses

Primary practice location

7715 SE Grant St
Portland, OR 97215-4116

Mailing address

7715 SE Grant St
Portland, OR 97215-4116
Phone (503) 774-4418

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131004000279 OR Practitioner - Chiropractic 0244471688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 1995
Medicare assignment
May accept Medicare assignment
Group practices
Center for Chiropractic and Pain Rehabilitation, LLCGroup PAC ID 5991603268, 5 clinicians

Practice addresses (Care Compare)

3241 NE Broadway St
Portland, OR 97232-1814
Phone (503) 282-8582

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27 2964ORMDChiropractor
2964ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Chiropractic & Pain Rehabilitation, LLC CurrentSince Oct 1, 2012 Accepting new patients

Locations

3241 NE Broadway St
Portland, OR 97232
Phone (503) 267-9080

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104994581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7715 SE GRANT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972154116",
            "telephone_number": "503-774-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7715 SE GRANT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972154116",
            "telephone_number": "503-774-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYKES",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "27 2964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.