Active NPI
Thomas Vanidestine, D.C.
- Chiropractor
- Tigard, OR
National Provider Identifier
1811439136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5773
- Practice address
- 9975 SW Frewing St
Suite #210
Tigard, OR 97223-5091 - Phone
- (503) 444-1953
- Fax
- (971) 244-7246
- NPI assigned
- Nov 17, 2016
- Last updated
- Aug 30, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5773 | OR | Primary |
Addresses
Primary practice location
9975 SW Frewing St
Suite #210
Tigard, OR 97223-5091
Mailing address
9975 SW Frewing St
Suite #210
Tigard, OR 97223-5091
Phone (503) 444-1953
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5773 | OR | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Accident Care Chiropractic and Massage of Tigard | Chiropractor | Past | Accepting new patients |
| Active Acupuncture Chiropractic and Massage LLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Tigard, OR
- NPI 1447600341
-
- Chiropractor
- Portland, OR
- NPI 1518454727
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1811439136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9975 SW FREWING ST",
"address_2": "SUITE #210",
"city": "TIGARD",
"state": "OR",
"postal_code": "972235091",
"telephone_number": "503-444-1953",
"fax_number": "971-244-7246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9975 SW FREWING ST",
"address_2": "SUITE #210",
"city": "TIGARD",
"state": "OR",
"postal_code": "972235091",
"telephone_number": "503-444-1953",
"fax_number": "971-244-7246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANIDESTINE",
"first_name": "THOMAS",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-17",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "5773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.