Mary Ann Tack, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

27 2863 Issued in OR

Practice address

901 Brutscher St
Ste 210
Newberg, OR 97132-6095

Phone

(503) 537-2052

Fax

(503) 538-8315

NPI assigned

Sep 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 1993

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifestreams Chiropractic Center, LLC

  • Chiropractor
  • Newberg, OR
  • NPI 1942588785
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592524800000",
    "number": "1346347929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 BRUTSCHER ST",
            "address_2": "STE 210",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971326095",
            "telephone_number": "503-537-2052",
            "fax_number": "503-538-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BRUTSCHER ST",
            "address_2": "STE 210",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971326095",
            "telephone_number": "503-537-2052",
            "fax_number": "503-538-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACK",
        "first_name": "MARY ANN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-17",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "27  2863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274833",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katharine Leilani Suppan, LMT
• Mindy Giskaas Sutton
• Alexander Raymond Swartz, DPT
• Jeremy S. Swindle, MD
• Brittni Swink
• Lacy Taghon, LMT
• Debbie Sue Taylor, LMT
• Jeremy Wade Taylor, O.D.
• Paula Ann Taylor, O.D.
• Sharron Elaine Taylor, RN

• Chiropractor in Newberg, OR
• Providers in Newberg, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.