Victory Spine and Sport PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

VICTORY SPINE AND SPORT PLLC

Doing business as

Victory Spine and Sport

Practice address

16508 SE 24TH St Ste 203
Vancouver, WA 98683-4321

Phone

(360) 818-4626

Fax

(360) 208-0293

NPI assigned

Nov 6, 2020

Last updated

Dec 2, 2021By 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

Dustin Henry, DCNPI 1891240248

Title

Owner

Phone

(360) 818-4626

Specialties & licenses 1

Addresses

Other names 1

• Victory Spine and Sport Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

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.

• Dustin Henry, DC, MS

  • Chiropractor
  • Vancouver, WA
  • NPI 1891240248
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638403200000",
    "number": "1780285510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16508 SE 24TH ST STE 203",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834321",
            "telephone_number": "360-818-4626",
            "fax_number": "360-208-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16508 SE 24TH ST STE 203",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834321",
            "telephone_number": "360-818-4626",
            "fax_number": "360-208-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY SPINE AND SPORT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-06",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-818-4626",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Spine and Sport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Victory Spine and Sport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ken Vickery, LCSW
• Kate Zebatto Victor, PA-C, MMS
• Victoria Paulus, LLC
• Clarence Gail Victoria, SLP
• Victory Athletic Exchange
• Jimena Vicuna
• Nancy Jo Vieira
• Tatiana Dawn Viera
• Sofia Viewkova
• Gary H Vigeant, LMP

• Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; 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.