NPIMap

Organization Active NPI

Pine Tree Chiropractic PC

  • Chiropractor
  • Klamath Falls, OR
National Provider Identifier
1861677783
Registry record updated Jan 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0700001797 Issued in OR
Legal business name
PINE TREE CHIROPRACTIC PC
Practice address
2515 Crosby Ave
Klamath Falls, OR 97603-4553
Phone
(541) 883-2225
Fax
(541) 882-9388
NPI assigned
Jan 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2011

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

Authorized official

Name
Dr. Scott G Wallace, D.C.NPI 1770655342
Title
Owner/President
Phone
(541) 883-2225

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 0700001797 OR Primary

Addresses

Primary practice location

2515 Crosby Ave
Klamath Falls, OR 97603-4553

Mailing address

2515 Crosby Ave
Klamath Falls, OR 97603-4553
Phone (541) 883-2225

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412001620 OR Part B Supplier - Clinic/Group Practice 3971597006 Receives reassigned benefits from 3 practitioners
Practice locations: Klamath Falls, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294963200000",
    "number": "1861677783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 CROSBY AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034553",
            "telephone_number": "541-883-2225",
            "fax_number": "541-882-9388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 CROSBY AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034553",
            "telephone_number": "541-883-2225",
            "fax_number": "541-882-9388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE TREE CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2011-01-14",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "541-883-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "0700001797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; 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.