Ruslan Perederey

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH60760768 Issued in WA

Practice address

3008 SW Chastain Ave
Gresham, OR 97080-9613

Phone

(503) 572-2293

NPI assigned

Jul 27, 2017

Last updated

Mar 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1720502180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 SW CHASTAIN AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970809613",
            "telephone_number": "503-757-8529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3008 SW CHASTAIN AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970809613",
            "telephone_number": "503-572-2293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREDEREY",
        "first_name": "RUSLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-27",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60760768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mia Peeler
• Deborah Anne Pegram, QMHA
• Yeidis Pena Alcantara, MEDICAL INTERPRETER
• Melissa Penington, OTR
• Avery Elizabeth Peraza, DPT
• Nadejda Pereverzina, L.M.T.
• Performance Modalities Inc (Performance Home Medical)
• Izzabella Perini
• Renee L Perkins, CADC II/CGAC I
• Shantel Perkins

• Chiropractor in Gresham, OR
• Providers in Gresham, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.

Verify at the official NPI Registry.