Active NPI
Justin Souvanlasy, DC
- Chiropractor
- Portland, OR
National Provider Identifier
1144957689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 6169
- Practice address
- 8136 SE Foster Rd
Portland, OR 97206-4288 - Phone
- (503) 374-9995
- NPI assigned
- Aug 4, 2022
- Last updated
- Mar 30, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6169 | OR | Primary |
Addresses
Primary practice location
8136 SE Foster Rd
Portland, OR 97206-4288
Mailing address
9841 SE Hult St
Portland, OR 97266-1341
Phone (971) 240-8512
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6169 | OR | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1144957689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9841 SE HULT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972661341",
"telephone_number": "971-240-8512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8136 SE FOSTER RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972064288",
"telephone_number": "503-374-9995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUVANLASY",
"first_name": "JUSTIN",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-04",
"last_updated": "2023-03-30",
"certification_date": "2023-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "6169",
"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 Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.