Active NPI
Dmitriy Tupikov, D.C.
- Chiropractor
- Portland, OR
National Provider Identifier
1316392814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5722
- Practice address
- 11679 NE Glisan St
Portland, OR 97220-2264 - Phone
- (971) 373-8257
- Fax
- (971) 373-8259
- NPI assigned
- May 3, 2016
- 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 | 5722 | OR | Primary |
Addresses
Primary practice location
11679 NE Glisan St
Portland, OR 97220-2264
Mailing address
11679 NE Glisan St
Portland, OR 97220-2264
Phone (971) 373-8257
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500742574 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190607002192 | OR | Practitioner - Chiropractic | 5294068193 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5722 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557705600000",
"number": "1316392814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11679 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972202264",
"telephone_number": "971-373-8257",
"fax_number": "971-373-8259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11679 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972202264",
"telephone_number": "971-373-8257",
"fax_number": "971-373-8259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUPIKOV",
"first_name": "DMITRIY",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-03",
"last_updated": "2019-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "5722",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500742574",
"state": "OR"
}
],
"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 May 13, 2019; 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.