Cascade Park Sports Medicine & Rehab Clinic PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00002108 Issued in WA

Legal business name

CASCADE PARK SPORTS MEDICINE & REHAB CLINIC PLLC

Practice address

12214 SE Mill Plain Blvd
Ste 101
Vancouver, WA 98684-6019

Phone

(360) 254-4040

Fax

(360) 253-7808

NPI assigned

Dec 1, 2006

Last updated

Sep 13, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lucas Q Homer, DCNPI 1902090509

Title

Owner

Phone

(360) 254-4040

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lucas Q Homer, DC

  • Chiropractor
  • Vancouver, WA
  • NPI 1902090509
  NPD (past) Authorized official
• James H Isaak, PHYSICAL THERAPIST

  • Physical Therapist
  • Vancouver, WA
  • NPI 1417025131
  NPD (past)
• Robert A Goldman, P.T.

  • Physical Therapist
  • Fort Myers, FL
  • NPI 1144415571
  NPD (past)

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1679641393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12214 SE MILL PLAIN BLVD",
            "address_2": "STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846019",
            "telephone_number": "360-254-4040",
            "fax_number": "360-253-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12214 SE MILL PLAIN BLVD",
            "address_2": "STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846019",
            "telephone_number": "360-254-4040",
            "fax_number": "360-253-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASCADE PARK SPORTS MEDICINE & REHAB CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "HOMER",
        "authorized_official_first_name": "LUCAS",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-254-4040",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cascade Medical Supply, Inc.
• Cascade Park Care Center/Life Care Centers of America
• Cascade Park Chiropractic Clinic PLLC
• Cascade Park Pharmacy Inc (Ready Meds Pharmacy)
• Cascade Park Specialty Care Home LLC
• Cascade Pathology Services, Corp
• Cascade Physical Therapy LLC
• Cascade Surgical Physician Assistants, PLLC
• Cascadia Cruise Co.
• Cascadia Health Care, P.C.

• Chiropractor in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.