Kruse Park Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3897 Issued in OR

Legal business name

KRUSE PARK CHIROPRACTIC LLC

Practice address

3990 Collins Way Ste 201
Lake Oswego, OR 97035-3459

Phone

(503) 635-1236

NPI assigned

Jul 26, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Bronwyn Illingworth, DC, MS, BSNPI 1669709598

Title

Owner

Phone

(503) 593-4719

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bronwyn Illingworth, D.C.

  • Chiropractor
  • Lake Oswego, OR
  • NPI 1669709598
  Medicare reassignment Care Compare group NPD Authorized official
• Jennie-Marie Evanka Archambault, DC

  • Chiropractor
  • Lake Oswego, OR
  • NPI 1043792856
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532563200000",
    "number": "1700363389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1609",
            "city": "LAKE GROVE",
            "state": "OR",
            "postal_code": "970350809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 COLLINS WAY STE 201",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353459",
            "telephone_number": "503-635-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRUSE PARK CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2018-07-26",
        "status": "A",
        "authorized_official_last_name": "ILLINGWORTH",
        "authorized_official_first_name": "BRONWYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-593-4719",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, MS, BS"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "3897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KP Chiropractic Services PC (Encompass Chiropractic Health)
• Amy Krause
• Jenna Krevosky, M.ED
• Kristina E Harp M.D P.C
• Kruse Park Chiropractic Clinic LLC
• Christopher William Kryger, LCSW
• Wendy Luo Kryski
• Sayali D Kulkarni, FNP
• Feben Kurban, AU.D.
• Corinne Andreana Kuszik

• 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 26, 2018; 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.