Individual provider Active NPI

Matthew Jonathan Sanicki, D.C.

  • Chiropractor
  • San Diego, CA
National Provider Identifier
1114137361
Registry record updated Aug 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC28735 Issued in CA
Practice address
2751 Roosevelt Rd
Building 210, Suite 203
San Diego, CA 92106-6180
Phone
(619) 795-2224
Fax
(619) 793-5517
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 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 DC28735 CA Primary

Addresses

Primary practice location

2751 Roosevelt Rd
Building 210, Suite 203
San Diego, CA 92106-6180

Mailing address

2902 Poinsettia Dr
San Diego, CA 92106-1128
Phone (619) 501-1673

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

Practice roles

OrganizationSpecialtyStatusNew patients
Coulsby Chiropractic, P.C. Past Accepting new patients
Matthew Sanicki Chiropractic Inc Chiropractor Past Accepting new patients

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": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251072000000",
    "number": "1114137361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 POINSETTIA DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921061128",
            "telephone_number": "619-501-1673",
            "fax_number": "619-299-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 ROOSEVELT RD",
            "address_2": "BUILDING 210, SUITE 203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921066180",
            "telephone_number": "619-795-2224",
            "fax_number": "619-793-5517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANICKI",
        "first_name": "MATTHEW",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2009-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC28735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; 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.