Healthcare Provider Details

I. General information

NPI: 1316693591
Provider Name (Legal Business Name): PNW SPINE AND JOINT PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 NE 7TH AVE STE 206
PORTLAND OR
97212-3998
US

IV. Provider business mailing address

1836 NE 7TH AVE STE 206
PORTLAND OR
97212-3998
US

V. Phone/Fax

Practice location:
  • Phone: 503-553-0334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRK ELLIOT WHETSTONE
Title or Position: OWNER
Credential: MD
Phone: 503-554-0334