NPIMap

Organization Active NPI

Whitaker Wellness LLC

Doing business as Powell Valley Chiropractic Clinic

  • Clinic/Center
  • Gresham, OR
National Provider Identifier
1831641505
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5545 Issued in OR
Legal business name
WHITAKER WELLNESS LLC
Doing business as
Powell Valley Chiropractic Clinic
Practice address
4253 SE 182ND Ave
Gresham, OR 97030-5083
Phone
(503) 661-5090
NPI assigned
Oct 28, 2016
Last updated
Oct 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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

Authorized official

Name
Dr. Michael Robert Whitaker, D.C.NPI 1689097503
Title
Member
Phone
(503) 661-5090

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
Clinic/Center 261Q00000X 5545 OR Primary

Addresses

Primary practice location

4253 SE 182ND Ave
Gresham, OR 97030-5083

Mailing address

4253 SE 182ND Ave
Gresham, OR 97030-5083
Phone (503) 661-5090

Other names 1

  • Powell Valley Chiropractic Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161230001167 OR Part B Supplier - Clinic/Group Practice 6103107313 Receives reassigned benefits from 1 practitioner
Practice locations: Gresham, OR

National Provider Directory

National Provider Directory

Locations

4253 SE 182nd Ave
Gresham, OR 97030
Phone (503) 661-5090

Practitioners & affiliated clinicians

Practitioners 11

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": "1477612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477612800000",
    "number": "1831641505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4253 SE 182ND AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305083",
            "telephone_number": "503-661-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4253 SE 182ND AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305083",
            "telephone_number": "503-661-5090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITAKER WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-661-5090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "5545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powell Valley Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2016; 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.