NPIMap

Organization Active NPI

MDC Chiropractic LLC

  • Chiropractor
  • Portland, OR
National Provider Identifier
1326456641
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4452 Issued in OR
Legal business name
MDC CHIROPRACTIC LLC
Practice address
4410 NE Fremont St.
Portland, OR 97213
Phone
(503) 249-0114
Fax
(503) 214-8175
NPI assigned
Jul 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Authorized official

Name
Dr. Eddy Mydouangchanh, DC
Title
Owner
Phone
(503) 249-0114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4452 OR Primary

Addresses

Primary practice location

4410 NE Fremont St.
Portland, OR 97213

Mailing address

4410 NE Fremont St.
Portland, OR 97213-1154
Phone (503) 249-0114

National Provider Directory

National Provider Directory

Locations

4410 NE Fremont St
Portland, OR 97213
Phone (503) 249-0114

Practitioners & affiliated clinicians

Practitioners 5

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": "1406678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1326456641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 NE FREMONT ST.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131154",
            "telephone_number": "503-249-0114",
            "fax_number": "503-214-8175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 NE FREMONT ST.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97213",
            "telephone_number": "503-249-0114",
            "fax_number": "503-214-8175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDC CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-30",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "MYDOUANGCHANH",
        "authorized_official_first_name": "EDDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-249-0114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "4452",
            "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 Aug 7, 2018; 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.