Chiropractic Life Center PC

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

271737 Issued in OR

Legal business name

CHIROPRACTIC LIFE CENTER PC

Doing business as

Chiropractic Life Center

Practice address

12762 SE Stark St
Plaza 125, BLDG D
Portland, OR 97233-1539

Phone

(503) 255-7746

Fax

(503) 255-0818

NPI assigned

Apr 4, 2008

Organization subpart

No

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

Authorized official

Name

Mark Ronald Johansen, DCNPI 1255680831

Title

Owner

Phone

(503) 255-7746

Specialties & licenses 1

Addresses

Other names 1

• Chiropractic Life Center Doing business as

Locations

Practitioners 3

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.

• Mark Ronald Johansen, D.C.

  • Chiropractor
  • Portland, OR
  • NPI 1255680831
  NPD (past) Authorized official
• James Lee Andrews, D.C.

  • Chiropractor
  • Portland, OR
  • NPI 1043301088
  NPD (past)
• Ronald R Johansen, D.C.

  • Orthopedic Chiropractor
  • Portland, OR
  • NPI 1043302409
  NPD (past)

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

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564617600000",
    "number": "1235302795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12762 SE STARK ST",
            "address_2": "PLAZA 125, BLDG D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331539",
            "telephone_number": "503-255-7746",
            "fax_number": "503-255-0818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12762 SE STARK ST",
            "address_2": "PLAZA 125, BLDG D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331539",
            "telephone_number": "503-255-7746",
            "fax_number": "503-255-0818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC LIFE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-04",
        "last_updated": "2019-08-01",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-255-7746",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "OR",
            "license": "271737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chiropractic Life Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chiropractic Life Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthopedic Chiropractor in Portland, OR
• Providers in Portland, OR by specialty
• Orthopedic Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; 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.