Keith D Johns, DC
Individual provider Active NPI Chiropractor · Milwaukie, OR
NPI 1336217280 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1336217280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 272572 (OR)
- Practice address
- 3716 SE International Way
Milwaukie, OR 97222 - Phone
- (503) 659-0073
- Fax
- (503) 659-7471
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 1989
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Keith D. Johns D.C., P.C.
Practice addresses (Care Compare)
3716 SE International Way
Milwaukie, OR 97222-6001
Phone 503659007319
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080801000618 | OR | Practitioner - Chiropractic | 9830263201 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 272572 | OR | MD | Chiropractor |
| 2572 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Keith D. Johns D.C., P.C. | Chiropractor | Current |
Accepting new patients |
| Milwaukie Chiropractic Center | Chiropractor | Current | Accepting new patients |
Locations
3716 SE International Way
Portland, OR 97222
Phone (503) 659-0073
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 272572 | OR | Yes |
Addresses
Primary practice location
3716 SE International Way
Milwaukie, OR 97222
Mailing address
J2272 SE One Rosa Drive
Clackamus, OR 97015
Phone (503) 888-1028
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30176 | Other | WA | DEPT OF LABOR & INDIS |
| 370939 | Other | AMERICAN SPECIALITY PB |
Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.