NPIMap

Organization Active NPI

D'Vida Injury Clinic & Wellness Center LLC

  • Chiropractor
  • Beaverton, OR
National Provider Identifier
1861754517
Registry record updated Jun 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4077 Issued in OR
Legal business name
D'VIDA INJURY CLINIC & WELLNESS CENTER LLC
Practice address
14195 SW Allen Blvd
Beaverton, OR 97005-4408
Phone
(503) 626-2166
Fax
(503) 641-6665
NPI assigned
Jun 8, 2012
Last updated
Jun 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2014

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

Authorized official

Name
Michelle Whittaker, LACNPI 1275767402
Title
Owner
Phone
(503) 626-2166

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 4077 OR Primary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X AC01279 OR

Addresses

Primary practice location

14195 SW Allen Blvd
Beaverton, OR 97005-4408

Mailing address

14195 SW Allen Blvd
Beaverton, OR 97005-4408
Phone (503) 626-2166

Other names 1

  • D'Vida Clinic Other name

National Provider Directory

National Provider Directory

Locations

14195 SW Allen Blvd
Beaverton, OR 97005
Phone (503) 626-2166

3835 SW 185th Ave
Ste 400
Beaverton, OR 97078
Phone (503) 626-2166

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403827200000",
    "number": "1861754517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14195 SW ALLEN BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054408",
            "telephone_number": "503-626-2166",
            "fax_number": "503-641-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14195 SW ALLEN BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054408",
            "telephone_number": "503-626-2166",
            "fax_number": "503-641-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D'VIDA INJURY CLINIC & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-08",
        "last_updated": "2014-06-27",
        "status": "A",
        "authorized_official_last_name": "WHITTAKER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-626-2166",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "4077",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC01279",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "D'Vida Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; 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.