NPIMap

Organization Active NPI

Beacon Chiropractic Co

  • Chiropractor
  • Vancouver, WA
National Provider Identifier
1699199109
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
BEACON CHIROPRACTIC CO
Practice address
11500 NE 119TH St Ste 104
Vancouver, WA 98662-1643
Phone
(360) 326-3396
Fax
(360) 369-0015
NPI assigned
Feb 5, 2014
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Dr. David Isaac Johnson, D.C.NPI 1003238148
Title
Ceo, Chiropractor
Phone
(360) 326-3396

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X

Addresses

Primary practice location

11500 NE 119TH St Ste 104
Vancouver, WA 98662-1643

Mailing address

11500 NE 119TH St Ste 104
Vancouver, WA 98662-1643
Phone (360) 326-3396

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221114000089 WA Part B Supplier - Clinic/Group Practice 5991172439 Receives reassigned benefits from 1 practitioner
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

11500 NE 119th St
Ste 104
Vancouver, WA 98662
Phone (360) 326-3396

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1699199109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 NE 119TH ST STE 104",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986621643",
            "telephone_number": "360-326-3396",
            "fax_number": "360-369-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 NE 119TH ST STE 104",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986621643",
            "telephone_number": "360-326-3396",
            "fax_number": "360-369-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON CHIROPRACTIC CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-05",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ISAAC",
        "authorized_official_title_or_position": "CEO, CHIROPRACTOR",
        "authorized_official_telephone_number": "360-326-3396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.