Wellbridge Pain Care LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC161027 Issued in OR

Legal business name

WELLBRIDGE PAIN CARE LLC

Doing business as

The WellBridge Clinic

Practice address

3705 SE Cesar Chavez Blvd.
Portland, OR 97202

Phone

(503) 544-9611

Fax

(971) 339-3897

NPI assigned

Jun 4, 2014

Last updated

Jan 9, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Alan Rybak, L.AC

Title

Owner

Phone

(503) 544-9611

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The WellBridge Clinic Doing business as

Locations

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641686400000",
    "number": "1356754691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 SE CESAR CHAVEZ BLVD.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97202",
            "telephone_number": "503-544-9611",
            "fax_number": "971-339-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 SE CESAR CHAVEZ BLVD.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97202",
            "telephone_number": "503-544-9611",
            "fax_number": "971-339-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLBRIDGE PAIN CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-04",
        "last_updated": "2022-01-09",
        "certification_date": "2022-01-09",
        "status": "A",
        "authorized_official_last_name": "RYBAK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-544-9611",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.AC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC161027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500727866",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The WellBridge Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2022; 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.