Active NPI
David Scott Conklin, D.C.
- Chiropractor
- Portland, OR
National Provider Identifier
1316017593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2681
- Practice address
- 4309 SE Woodstock Blvd
Suite 120
Portland, OR 97206-6212 - Phone
- (503) 777-4221
- Fax
- (503) 777-4349
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 2681 | OR | Primary |
Addresses
Primary practice location
4309 SE Woodstock Blvd
Suite 120
Portland, OR 97206-6212
Mailing address
4309 SE Woodstock Blvd
Suite 120
Portland, OR 97206-6212
Phone (503) 777-4221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040525001073 | OR | Practitioner - Chiropractic | 1951382191 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339372800000",
"number": "1316017593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4309 SE WOODSTOCK BLVD",
"address_2": "SUITE 120",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972066212",
"telephone_number": "503-777-4221",
"fax_number": "503-777-4349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4309 SE WOODSTOCK BLVD",
"address_2": "SUITE 120",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972066212",
"telephone_number": "503-777-4221",
"fax_number": "503-777-4349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "DAVID",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2012-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "2681",
"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 Jun 11, 2012; 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.