Provider Type Icon

ILLUMINATION ROCK INTEGRATIVE MEDICINE LLC NPI 1356905855


NPI Information

NPI: 1356905855
Provider Name: ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
4035 SE 52ND AVE STE B
PORTLAND, OR
ZIP 97206
Phone: (503) 482-7556
Get Directions

ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC is a clinic center in Portland, OR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC NPI is 1356905855. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4035 SE 52ND AVE STE B
PORTLAND, OR
ZIP 97206-913
Phone: (503) 482-7556
Fax: (971) 244-9171

The provider's authorized official is Kirsten Karen Isakson .
The authorized official title is Managing Member and has the following contact phone number (971) 229-2140.

The enumeration date for this NPI number is 4/30/2019 and was last updated on 3/30/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12081P2900XPhysical Medicine & RehabilitationPain MedicineNo
2171100000XAcupuncturistNo
3175F00000XNaturopathNo
42081N0008XPhysical Medicine & RehabilitationNeuromuscular MedicineNo
5225700000XMassage TherapistNo
6261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1500703138MEDICAIDOREGON
21932568458OTHERNPI TYPE 1

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.