Active NPI
Mark T Elliott, DC
- Chiropractor
- Vista, CA
National Provider Identifier
1114967122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC21313
- Practice address
- 1621 S Melrose Dr
Suite F
Vista, CA 92081-5401 - Phone
- (760) 598-9200
- Fax
- (760) 598-9202
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC21313 | CA | Primary |
Addresses
Primary practice location
1621 S Melrose Dr
Suite F
Vista, CA 92081-5401
Mailing address
1621 S Melrose Dr
Suite F
Vista, CA 92081-5401
Phone (760) 598-9200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC21313 | Other | CA | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040414000536 | CA | Practitioner - Chiropractic | 5799779575 | Practice locations: Vista, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1991
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3231 Business Park Dr
Suite B
Vista, CA 92081-8531
Phone (760) 598-9200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC21313 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297728000000",
"number": "1114967122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 S MELROSE DR",
"address_2": "SUITE F",
"city": "VISTA",
"state": "CA",
"postal_code": "920815401",
"telephone_number": "760-598-9200",
"fax_number": "760-598-9202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1621 S MELROSE DR",
"address_2": "SUITE F",
"city": "VISTA",
"state": "CA",
"postal_code": "920815401",
"telephone_number": "760-598-9200",
"fax_number": "760-598-9202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "MARK",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2011-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC21313",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "DC21313",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; 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.