Illumination Rock Integrative Medicine, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC

Practice address

4035 SE 52ND Ave Ste B
Portland, OR 97206-3913

Phone

(503) 482-7556

Fax

(971) 244-9171

NPI assigned

Apr 30, 2019

Organization subpart

No

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

Authorized official

Name

Kirsten Karen Isakson, LAC

Title

Managing Member

Phone

(971) 229-2140

Specialties & licenses 6

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kirsten Karen Isakson Waters, RN, LAC

  • Acupuncturist
  • Portland, OR
  • NPI 1932568458
  NPD

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1356905855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4035 SE 52ND AVE STE B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972063913",
            "telephone_number": "971-229-2140",
            "fax_number": "971-244-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 SE 52ND AVE STE B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972063913",
            "telephone_number": "503-482-7556",
            "fax_number": "971-244-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "ISAKSON",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "KAREN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "971-229-2140",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081N0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Neuromuscular Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1932568458",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500703138",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony R Illo, D.C.
• Illumina Integrative Psychiatry
• Illuminate and Liberate Counseling, LLC
• Illuminate Healing LLC
• Illumination Counseling LLC
• Marissa Ilnitzki
• Sandra Iloka, M.D.
• Kelly Ann Ilseman, MACOM, MS, MED
• Justin Yohalem Ilsley, ND
• Jin Seon Im, M.D.

• Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.