Bronwyn Illingworth, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3897 Issued in OR

Practice address

3990 Collins Way
Suite 201
Lake Oswego, OR 97035-3549

Phone

(503) 635-1236

Fax

(503) 697-4741

NPI assigned

Nov 13, 2009

Sex

Female

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

Enrolled in OR

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kruse Park Chiropractic LLCGroup PAC ID 9032453568, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kruse Park Chiropractic LLC

  • Chiropractor
  • Lake Oswego, OR
  • NPI 1700363389
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1258070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1669709598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 COLLINS WAY",
            "address_2": "SUITE 201",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 COLLINS WAY",
            "address_2": "SUITE 201",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353549",
            "telephone_number": "503-635-1236",
            "fax_number": "503-697-4741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLINGWORTH",
        "first_name": "BRONWYN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-13",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "3897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Amanda J Ihle, LCSW
• Bethany Jean Iltis, PHARM.D.
• Loveline Ozioma Imanatue, DNP
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• Chiropractor in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; 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.