NPIMap

Organization Active NPI

Sheridan Family Chiropractic PC

  • Chiropractor
  • Sheridan, OR
National Provider Identifier
1790951440
Registry record updated Jun 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
651343 Issued in OR
Legal business name
SHERIDAN FAMILY CHIROPRACTIC PC
Practice address
639 W Main
Sheridan, OR 97378
Phone
(503) 843-3888
Fax
(503) 843-4366
NPI assigned
May 2, 2008
Last updated
Jun 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2015

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

Authorized official

Name
Dr. Kenneth A Kelley, DCNPI 1902878333
Title
Owner
Phone
(503) 843-3888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 651343 OR Primary

Addresses

Primary practice location

639 W Main
Sheridan, OR 97378

Mailing address

PO Box 37
Sheridan, OR 97378-0037
Phone (503) 843-3888

Other identifiers 2

IdentifierTypeStateIssuer
112941OtherORPERMANENTE
059489000OtherREGENCE BC BS

National Provider Directory

National Provider Directory

Locations

639 W Main St
Sheridan, OR 97378
Phone (503) 843-3888

Practitioners & affiliated clinicians

Practitioners 3

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": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435363200000",
    "number": "1790951440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "SHERIDAN",
            "state": "OR",
            "postal_code": "973780037",
            "telephone_number": "503-843-3888",
            "fax_number": "503-843-4366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 W MAIN",
            "city": "SHERIDAN",
            "state": "OR",
            "postal_code": "97378",
            "telephone_number": "503-843-3888",
            "fax_number": "503-843-4366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERIDAN FAMILY CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-02",
        "last_updated": "2015-06-27",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-843-3888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "651343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERMANENTE",
            "identifier": "112941",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BC BS",
            "identifier": "059489000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheridan, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2015; 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.