NPIMap

Organization Active NPI

Custom Chiropractic & Wellness Clinic LLC

  • Chiropractor
  • Medford, OR
National Provider Identifier
1134565302
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4067 Issued in OR
Legal business name
CUSTOM CHIROPRACTIC & WELLNESS CLINIC LLC
Practice address
1910 E Barnett Rd
Ste #103
Medford, OR 97504-8672
Phone
(541) 245-9544
Fax
(541) 245-9574
NPI assigned
May 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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

Authorized official

Name
Dr. Joshua David Fine, D.C.
Title
Owner/Operator
Phone
(541) 245-9544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 4067 OR Primary

Addresses

Primary practice location

1910 E Barnett Rd
Ste #103
Medford, OR 97504-8672

Mailing address

1910 E Barnett Rd
Ste #103
Medford, OR 97504-8672
Phone (541) 245-9544

National Provider Directory

National Provider Directory

Locations

1910 E Barnett Rd
Ste 103
Medford, OR 97504
Phone (541) 245-9544

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1134565302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 E BARNETT RD",
            "address_2": "STE #103",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-245-9544",
            "fax_number": "541-245-9574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 E BARNETT RD",
            "address_2": "STE #103",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-245-9544",
            "fax_number": "541-245-9574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CHIROPRACTIC & WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "FINE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "541-245-9544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "4067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.