Individual provider Active NPI

Mark Michio Adachi, DC

  • Chiropractor
  • Glendale, CA
National Provider Identifier
1063631422
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC16166 Issued in CA
Practice address
411 N Central Ave #325
#325
Glendale, CA 91203-2055
Phone
(818) 243-4353
Fax
(818) 240-5245
NPI assigned
Apr 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC16166 CA Primary

Addresses

Primary practice location

411 N Central Ave #325
#325
Glendale, CA 91203-2055

Mailing address

411 N Central Ave #325
#325
Glendale, CA 91203-2055
Phone (818) 243-4353

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090925000585 CA Practitioner - Chiropractic 9830245075

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

411 N Central Ave
Glandale, CA 91203-2055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC16166CAMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245110400000",
    "number": "1063631422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE #325",
            "address_2": "#325",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032055",
            "telephone_number": "818-243-4353",
            "fax_number": "818-240-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE #325",
            "address_2": "#325",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032055",
            "telephone_number": "818-243-4353",
            "fax_number": "818-240-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADACHI",
        "first_name": "MARK",
        "middle_name": "MICHIO",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2009-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC16166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; 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.