Individual provider Active NPI

Daryn Fanney, D.C.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1376826164
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH10331 Issued in FL
Practice address
2505 SW Spring Garden St Ste 100
Portland, OR 97219-3966
Phone
(503) 841-6222
NPI assigned
Sep 28, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6137 OR
Chiropractor 111N00000X CH10331 FL Primary

Addresses

Primary practice location

2505 SW Spring Garden St Ste 100
Portland, OR 97219-3966

Mailing address

5151 SE Holgate Blvd Apt 312
Portland, OR 97206-3887
Phone (407) 616-1982

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240730001384 OR Practitioner - Chiropractic 1951848704

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH10331FLMDChiropractor
6137ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Therapia P.C. PastSince Feb 24, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1376826164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 SE HOLGATE BLVD APT 312",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972063887",
            "telephone_number": "407-616-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 SW SPRING GARDEN ST STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972193966",
            "telephone_number": "503-841-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNEY",
        "first_name": "DARYN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-28",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "6137",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH10331",
            "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 Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.