John Michael Pellerin Jr., L.M.T.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

17829 Issued in OR

Practice address

21887 SW Sherwood Blvd Ste a
Sherwood, OR 97140-9412

Phone

(503) 625-0500

Fax

(503) 625-0119

NPI assigned

Dec 12, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Sherwood Boulevard Chiropractic, LLC

  dba Elite Spine and Sports

  • Chiropractor
  • Sherwood, OR
  • NPI 1770980021
  NPD (past)

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

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1407192891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21887 SW SHERWOOD BLVD STE A",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409412",
            "telephone_number": "503-625-0500",
            "fax_number": "503-625-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21887 SW SHERWOOD BLVD STE A",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409412",
            "telephone_number": "503-625-0500",
            "fax_number": "503-625-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLERIN",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_suffix": "Jr.",
        "credential": "L.M.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-12",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "17829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Owen, LMT
• Pacific Family Dental LLC
• Chung-Jae Park, DDS
• Bronwyn M Parkin, PHARM.D.
• Osa Briana Peck, RN, CDCES
• Petrotta Chiropractic Inc.
• Deborah Ann Petrotta, D.C.
• Li-Zandre Philbrook, PT, DPT
• Lauren Phillips, M.S. CF-SLP
• Cheryl Catherine Pierson, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; 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.