Active NPI
Charles Mark Logan, D.C.
- Chiropractor
- Medford, OR
National Provider Identifier
1386865483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3440
- Practice address
- 1064 E Jackson Street
Medford, OR 97504 - Phone
- (541) 776-4554
- Fax
- (541) 776-0954
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3440 | OR | Primary |
Addresses
Primary practice location
1064 E Jackson Street
Medford, OR 97504
Mailing address
1064 E Jackson Street
Medford, OR 97504
Phone (541) 776-4554
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3440 | OR | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386865483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1064 E JACKSON STREET",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-776-4554",
"fax_number": "541-776-0954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1064 E JACKSON STREET",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-776-4554",
"fax_number": "541-776-0954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "CHARLES",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "3440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.