NPIMap

Organization Active NPI

Functional Health Pain Management

  • Sports Physician Chiropractor
  • Portland, OR
National Provider Identifier
1295912202
Registry record updated Jan 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
1856 Issued in OR
Legal business name
FUNCTIONAL HEALTH PAIN MANAGEMENT
Practice address
6105 SW Macadam Ave
Portland, OR 97239-3640
Phone
(503) 244-0920
NPI assigned
Jan 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2008

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

Authorized official

Name
Dr. Dean Allen Clark, D.C.NPI 1750327318
Title
Owner
Phone
(503) 244-0920

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
Sports Physician ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111NS0005X 1856 OR Primary

Addresses

Primary practice location

6105 SW Macadam Ave
Portland, OR 97239-3640

Mailing address

6105 SW Macadam Ave
Portland, OR 97239-3640
Phone (503) 244-0920

National Provider Directory

National Provider Directory

Locations

6105 S Macadam Ave
Portland, OR 97239
Phone (503) 244-0920

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": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200960000000",
    "number": "1295912202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6105 SW MACADAM AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393640",
            "telephone_number": "503-244-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6105 SW MACADAM AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393640",
            "telephone_number": "503-244-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL HEALTH PAIN MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2008-01-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-244-0920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "1856",
            "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 Jan 22, 2008; 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.