Individual provider Active NPI

Christopher R Ennis, D.C

  • Chiropractor
  • Winston Salem, NC
National Provider Identifier
1023561875
Registry record updated Jul 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4651 Issued in NC
Practice address
1515 Hanes Mall Blvd
Winston Salem, NC 27103-1358
Phone
(336) 773-7373
NPI assigned
Jul 28, 2016
Last updated
Jul 28, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4651 NC Primary

Addresses

Primary practice location

1515 Hanes Mall Blvd
Winston Salem, NC 27103-1358

Mailing address

1515 Hanes Mall Blvd
Winston Salem, NC 27103-1358
Phone (336) 773-7373

Other identifiers 1

IdentifierTypeStateIssuer
89016APMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161010000272 NC Practitioner - Chiropractic 3779871660 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gys Chiro IncGroup PAC ID 9133146541, 8 clinicians

Practice addresses (Care Compare)

1515 Hanes Mall Blvd
Winston Salem, NC 27103-1358
Phone (336) 773-7373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Keith Clinic Estramonte Chiropractic Chiropractor CurrentSince Mar 15, 2022 Accepting new patients
Estramonte Chiropractic & Wellness Center East, P.a. Chiropractor CurrentSince Mar 15, 2022 Accepting new patients
Estramonte Chiropractic West PA Chiropractor CurrentSince Mar 15, 2022 Accepting new patients
Optimize Chiropractic, PLLC Chiropractor CurrentSince Jul 4, 2020 Accepting new patients
Estramonte Chiropractic & Wellness Center Chiropractor CurrentSince Aug 18, 2022 Accepting new patients
Gys Chiro Inc Chiropractor PastSince Jul 1, 2016 Accepting new patients

Locations

4016 Triangle Dr
Charlotte, NC 28208
Phone (704) 392-1338

402 E Sugar Creek Rd
Charlotte, NC 28213
Phone (704) 405-7000

5344 Central Ave
Charlotte, NC 28212
Phone (704) 568-4195

6859 South Blvd
Charlotte, NC 28217
Phone (704) 274-5477

19109 W Catawba Ave
Ste 100
Cornelius, NC 28031
Phone (248) 331-7950

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469664000000",
    "number": "1023561875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 HANES MALL BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031358",
            "telephone_number": "336-773-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HANES MALL BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031358",
            "telephone_number": "336-773-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "CHRISTOPHER",
        "middle_name": "R",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-28",
        "last_updated": "2016-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016AP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.