Active NPI
Krista Marie Obenlock, DSOM
- Acupuncturist
- Portland, OR
National Provider Identifier
1669073490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC197250
- Practice address
- 2408 N Baldwin St
Portland, OR 97217-6404 - Phone
- (503) 673-6038
- NPI assigned
- Nov 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC197250 | OR | Primary |
Addresses
Primary practice location
2408 N Baldwin St
Portland, OR 97217-6404
Mailing address
2408 N Baldwin St
Portland, OR 97217-6404
Phone (503) 673-6038
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 |
|---|---|---|---|
| AC197250 | OR | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604620800000",
"number": "1669073490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2408 N BALDWIN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972176404",
"telephone_number": "503-673-6038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2408 N BALDWIN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972176404",
"telephone_number": "503-673-6038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBENLOCK",
"first_name": "KRISTA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "DSOM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-06",
"last_updated": "2020-11-06",
"certification_date": "2020-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Acupuncturist",
"state": "OR",
"license": "AC197250",
"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 Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.