Healthcare Provider Details

I. General information

NPI: 1568728517
Provider Name (Legal Business Name): KINETIC INTEGRATION SPORTS INJURIES & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8196 SW HALL BLVD STE 112
BEAVERTON OR
97008-4676
US

IV. Provider business mailing address

5585 SW 160TH AVE
BEAVERTON OR
97007-3540
US

V. Phone/Fax

Practice location:
  • Phone: 503-924-6535
  • Fax: 503-270-5266
Mailing address:
  • Phone: 503-924-6535
  • Fax: 503-270-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3883
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DREW HOHENSEE
Title or Position: OWNER/MEMBER
Credential: DC, CCSP
Phone: 503-924-6535