NPIMap

Organization Active NPI

Brie Chani Henderson

Doing business as Family & Sports Chiropractic Clinic

  • Chiropractor
  • Vancouver, WA
National Provider Identifier
1730676545
Registry record updated Apr 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60200517 Issued in WA
Legal business name
BRIE CHANI HENDERSON
Doing business as
Family & Sports Chiropractic Clinic
Practice address
5514 NE 107TH Ave Ste 101
Vancouver, WA 98662-6346
Phone
(360) 254-0400
Fax
(360) 254-9022
NPI assigned
Apr 17, 2018
Last updated
Apr 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2018

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

Authorized official

Name
Dr. Brie Chani Henderson, DCNPI 1841595782
Title
Clinic Owner
Phone
(360) 254-0400

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH60200517 WA Primary

Addresses

Primary practice location

5514 NE 107TH Ave Ste 101
Vancouver, WA 98662-6346

Mailing address

5514 NE 107TH Ave Ste 101
Vancouver, WA 98662-6346
Phone (360) 254-0400

Other names 1

  • Family & Sports Chiropractic Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180612003072 WA Part B Supplier - Clinic/Group Practice 9032464292 Receives reassigned benefits from 1 practitioner
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

5514 NE 107th Ave
Ste 101
Vancouver, WA 98662
Phone (360) 254-0400

Practitioners & affiliated clinicians

Practitioners 6

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": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1730676545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5514 NE 107TH AVE STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626346",
            "telephone_number": "360-254-0400",
            "fax_number": "360-254-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5514 NE 107TH AVE STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626346",
            "telephone_number": "360-254-0400",
            "fax_number": "360-254-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIE CHANI HENDERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "BRIE",
        "authorized_official_middle_name": "CHANI",
        "authorized_official_title_or_position": "CLINIC OWNER",
        "authorized_official_telephone_number": "360-254-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60200517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family & Sports Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family & Sports Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 17, 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.