Complete Spine and Wellness Group, Inc

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

DC26382 Issued in CA

Legal business name

COMPLETE SPINE AND WELLNESS GROUP, INC

Practice address

1640 Newport Blvd Ste 220
Costa Mesa, CA 92627-3786

Phone

(949) 650-4362

Fax

(949) 650-4366

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mary Eberhart, DC, QMENPI 1437210275

Title

Ceo

Phone

(949) 650-4362

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Mary Carlyn Eberhart, D.C.

  • Chiropractor
  • Newport Beach, CA
  • NPI 1437210275
  Medicare reassignment NPD Authorized official
• Jason William Anderson, PT

  • Physical Therapist
  • Costa Mesa, CA
  • NPI 1639319924
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355184000000",
    "number": "1003038399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 220",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273786",
            "telephone_number": "949-650-4362",
            "fax_number": "949-650-4366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 220",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273786",
            "telephone_number": "949-650-4362",
            "fax_number": "949-650-4366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE SPINE AND WELLNESS GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2012-12-11",
        "status": "A",
        "authorized_official_last_name": "EBERHART",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-650-4362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, QME"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "DC26382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639319924",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Competent Caregiving
• Annette Conde, BCBA
• Melanie Wheeler Connell, MPT, MTC
• Connor Upper Cervical Chiro of So Cal
• Connor Upper Cervical Chiropractic of Southern California
• Kenneth Joseph Connor, D.C.

• Rehabilitation Chiropractor in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Rehabilitation Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; 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.