Provider Demographics
NPI:1568728517
Name:KINETIC INTEGRATION SPORTS INJURIES & REHABILITATION, LLC
Entity Type:Organization
Organization Name:KINETIC INTEGRATION SPORTS INJURIES & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOHENSEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:503-924-6535
Mailing Address - Street 1:5585 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3540
Mailing Address - Country:US
Mailing Address - Phone:503-924-6535
Mailing Address - Fax:503-270-5266
Practice Address - Street 1:8196 SW HALL BLVD STE 112
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4676
Practice Address - Country:US
Practice Address - Phone:503-924-6535
Practice Address - Fax:503-270-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111NS0005X, 171100000X, 225100000X, 225700000X
OR3883111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty