NPIMap

Individual provider Active NPI

Vladislav Kostin, D.C.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1649638073
Registry record updated Jan 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5706 Issued in OR
Practice address
205 NE 181St Ave
Portland, OR 97230-6615
Phone
(503) 512-7076
Fax
(503) 512-7092
NPI assigned
Jan 30, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5706 OR Primary

Addresses

Primary practice location

205 NE 181St Ave
Portland, OR 97230-6615

Mailing address

205 NE 181St Ave
Portland, OR 97230-6615
Phone (503) 512-7076

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

LicenseStateTypeSpecialty
5706ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Springwater Chiropractic Center LLC Chiropractor PastSince Sep 8, 2019 Accepting new patients
Springwater Chiropractic Inc 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": "1454112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454112000000",
    "number": "1649638073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 NE 181ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972306615",
            "telephone_number": "503-512-7076",
            "fax_number": "503-512-7092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 NE 181ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972306615",
            "telephone_number": "503-512-7076",
            "fax_number": "503-512-7092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTIN",
        "first_name": "VLADISLAV",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-30",
        "last_updated": "2016-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5706",
            "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 Jan 30, 2016; 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.