Individual provider Active NPI

Rosa Elena Vince, D.C.

  • Chiropractor
  • San Rafael, CA
National Provider Identifier
1114084852
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
18941 Issued in CA
Practice address
361 3Rd St
Suite D
San Rafael, CA 94901-3541
Phone
(415) 454-3717
Fax
(415) 454-4077
NPI assigned
Jan 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 18941 CA Primary

Addresses

Primary practice location

361 3Rd St
Suite D
San Rafael, CA 94901-3541

Mailing address

361 3Rd St
Suite D
San Rafael, CA 94901-3541
Phone (415) 454-3717

Other practice location 1

250 E Eau Gallie Blvd
Indian Harbour Beach, FL 32937-4874
Phone (321) 241-4801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120628000126 CA Practitioner - Chiropractic 2062677826 Reassigns benefits to 1 organization
I20250306002497 FL Practitioner - Chiropractic 2062677826 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Elena Vince D C a Chiropractic CorpGroup PAC ID 3274798137, 2 clinicians

Practice addresses (Care Compare)

361 3Rd St
Suite D
San Rafael, CA 94901-3580
Phone (415) 454-3717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18941CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Divine UC Chiropractic, PLLC Chiropractor CurrentSince Feb 14, 2025 Accepting new patients
Elena Vince D C a Chiropractic Corp Chiropractor CurrentSince Jun 26, 2012 Accepting new patients

Locations

361 3rd St
Ste D
San Rafael, CA 94901
Phone (415) 454-3717

250 E Eau Gallie Blvd
Indian Harbour Beach, FL 32937
Phone (321) 241-4801

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1114084852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 3RD ST",
            "address_2": "SUITE D",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013541",
            "telephone_number": "415-454-3717",
            "fax_number": "415-454-4077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 3RD ST",
            "address_2": "SUITE D",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013541",
            "telephone_number": "415-454-3717",
            "fax_number": "415-454-4077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 E Eau Gallie Blvd",
            "address_purpose": "LOCATION",
            "city": "Indian Harbour Beach",
            "state": "FL",
            "postal_code": "329374874",
            "country_code": "US",
            "telephone_number": "321-241-4801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VINCE",
        "first_name": "ROSA",
        "middle_name": "ELENA",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "18941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; 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.