Individual provider Active NPI

John O Renquist, DR OF CHIROPRACTIC

  • Chiropractor
  • Salem, OR
National Provider Identifier
1609884535
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
271348 Issued in OR
Practice address
1095 Liberty St SE
Salem, OR 97302
Phone
(503) 585-1282
Fax
(503) 585-5531
NPI assigned
Aug 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 271348 OR Primary

Addresses

Primary practice location

1095 Liberty St SE
Salem, OR 97302

Mailing address

1095 Liberty St SE
Salem, OR 97302
Phone (503) 585-1282

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110308000993 OR Practitioner - Chiropractic 2860674116 Practice locations: Salem, OR

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1977
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1095 Liberty St SE
Salem, OR 97302-4140
Phone (503) 585-1282

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
271348ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. John O. Renquist Chiropractor PastSince Sep 27, 1977 Accepting new patients
Dr. Brett Renquist D.C., L.Ac Chiropractor Past Accepting new patients

Organizations & group practices 2

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": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609884535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-585-1282",
            "fax_number": "503-585-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-585-1282",
            "fax_number": "503-585-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENQUIST",
        "first_name": "JOHN",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "DR OF CHIROPRACTIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "271348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.