Individual provider Active NPI

Kristian Roman, DR OF CHIROPRACTIC

  • Chiropractor
  • Fort Myers, FL
National Provider Identifier
1023862950
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
14791 Issued in FL
Practice address
3949 Evans Ave Ste 406
Fort Myers, FL 33901-9345
Phone
(239) 288-7274
NPI assigned
Apr 16, 2024
Last updated
Apr 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 14791 FL Primary

Addresses

Primary practice location

3949 Evans Ave Ste 406
Fort Myers, FL 33901-9345

Mailing address

3949 Evans Ave Ste 406
Fort Myers, FL 33901-9345
Phone (239) 288-7274

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14791FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Specific Care Chiropractic Inc Chiropractor CurrentSince Mar 30, 2024 Accepting new patients

Locations

461 Del Prado Blvd S
Ste C
Cape Coral, FL 33990
Phone (239) 800-4149

3949 Evans Ave
Ste 406
Fort Myers, FL 33901
Phone (239) 288-7274

403 Joan Ave N
Lehigh Acres, FL 33971
Phone (239) 369-9101

Organizations & group practices 1

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": "1713225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1023862950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3949 EVANS AVE STE 406",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019345",
            "telephone_number": "239-288-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3949 EVANS AVE STE 406",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019345",
            "telephone_number": "239-288-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "KRISTIAN",
        "credential": "DR OF CHIROPRACTIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-16",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "14791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.