Lifestreams Chiropractic Center, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LIFESTREAMS CHIROPRACTIC CENTER, LLC

Practice address

901 Brutscher St Ste 210
Newberg, OR 97132-6094

Phone

(503) 537-2052

Fax

(503) 538-8315

NPI assigned

Jul 27, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Mary Ann Tack, DCNPI 1346347929

Title

Chiropractor/Owner

Phone

(503) 537-2052

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mary Ann Tack, DC Other name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

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

• Mary Ann Tack, D.C.

  • Chiropractor
  • Newberg, OR
  • NPI 1346347929
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592524800000",
    "number": "1942588785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 BRUTSCHER ST STE 210",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971326094",
            "telephone_number": "503-537-2052",
            "fax_number": "503-538-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BRUTSCHER ST STE 210",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971326094",
            "telephone_number": "503-537-2052",
            "fax_number": "503-538-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAMS CHIROPRACTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-27",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A",
        "authorized_official_last_name": "TACK",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "503-537-2052",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "2863",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPECIFIED",
            "identifier": "0000QGHFP",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274833",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Ann Tack, DC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carla Ledva
• Joel Lee, RN B.S.N
• Ryan Gaberiel Lee
• Desiree Lynn Lefave, CPM, LDM
• Life Puzzle Counseling, Inc.
• Carol B. Lincer, RDH
• Carley Gage Lindsay, LCSW
• Lisa Marie Lipe, D.P.M.
• Vanessa L Little, LPC
• Lawrence R. Litwer, M.D.

• Chiropractor in Newberg, OR
• Providers in Newberg, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.