NPIMap

Organization Active NPI

Priority Life Chiropractic & Massage LLC

  • Chiropractor
  • Vancouver, WA
National Provider Identifier
1134344880
Registry record updated Jul 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH000343 Issued in WA
Legal business name
PRIORITY LIFE CHIROPRACTIC & MASSAGE LLC
Practice address
3401 SE 192ND Ave
Suite 107
Vancouver, WA 98683-1472
Phone
(360) 882-7733
Fax
(360) 254-6821
NPI assigned
Apr 16, 2007
Last updated
Jul 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2013

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

Authorized official

Name
Dr. Mignon Bles Cejalvo, DCNPI 1760406128
Title
Chiropractor
Phone
(360) 882-7733

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
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH000343 WA Primary

Addresses

Primary practice location

3401 SE 192ND Ave
Suite 107
Vancouver, WA 98683-1472

Mailing address

3401 SE 192ND Ave
Suite 107
Vancouver, WA 98683-1472
Phone (360) 882-7733

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510001216 WA Part B Supplier - Clinic/Group Practice 1951390467 Receives reassigned benefits from 4 practitioners
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

19215 SE 34th St
Ste 102
Camas, WA 98607
Phone (360) 882-7733

3401 SE 192nd Ave
Ste 107
Vancouver, WA 98683
Phone (360) 882-7733

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372723200000",
    "number": "1134344880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 SE 192ND AVE",
            "address_2": "SUITE 107",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986831472",
            "telephone_number": "360-882-7733",
            "fax_number": "360-254-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 SE 192ND AVE",
            "address_2": "SUITE 107",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986831472",
            "telephone_number": "360-882-7733",
            "fax_number": "360-254-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIORITY LIFE CHIROPRACTIC & MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2013-07-02",
        "status": "A",
        "authorized_official_last_name": "CEJALVO",
        "authorized_official_first_name": "MIGNON",
        "authorized_official_middle_name": "BLES",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "360-882-7733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH000343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 2, 2013; 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.