Modern Chiropractic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MODERN CHIROPRACTIC, LLC

Practice address

16679 Boones Ferry Rd Ste 105
Lake Oswego, OR 97035-4378

Phone

(503) 635-6005

NPI assigned

Nov 15, 2023

Organization subpart

No

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

Authorized official

Name

Philip Devasto, DCNPI 1548566227

Title

Owner

Phone

(617) 365-1527

Specialties & licenses 1

Addresses

Other names 1

• Modern Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

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

• Philip A. Devasto, D.C.

  • Chiropractor
  • Lake Oswego, OR
  • NPI 1548566227
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1972378438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD STE 105",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354378",
            "telephone_number": "503-635-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD STE 105",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354378",
            "telephone_number": "503-635-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-15",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "DEVASTO",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-365-1527",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Elise Mitchell, PHARMD
• Quinn Mitchell
• Michelle Mitsui, LCSW
• Sandra J. Miyamoto, O.D.
• Deborah Mize, RN
• Janice Carole Modesitt, L.M.T.
• Mary Moffit, PH.D.
• Erin R Molstad, PT
• Katherine L J Molyneux, PA-C
• Monarch Medical Group LLC

• Chiropractor in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.