Active NPI
Mary Ellen Wiesenfarth Simone
- Independent Medical Examiner Chiropractor
- Covina, CA
National Provider Identifier
1144597006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Medical Examiner Chiropractor
- License
- DC22891
- Practice address
- 275 W San Bernardino Rd
Covina, CA 91723-1516 - Phone
- (626) 967-3553
- Fax
- (626) 967-1523
- NPI assigned
- Nov 21, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC22891 | CA | |
| Occupational Health Chiropractor | 111NX0100X | DC22891 | CA | |
| Independent Medical Examiner Chiropractor | 111NI0013X | DC22891 | CA | Primary |
Addresses
Primary practice location
275 W San Bernardino Rd
Covina, CA 91723-1516
Mailing address
275 W San Bernardino Rd
Covina, CA 91723-1516
Phone (626) 967-3553
Other practice location 1
155 W Hospitality Ln Ste 105
San Bernardino, CA 92408-3317
Phone (909) 888-2210
Other practice location 2
411 N Central Ave
Glendale, CA 91203-2081
Phone (818) 244-6792
Other practice location 3
1850 E Palmdale Blvd
Palmdale, CA 93550-2026
Phone (661) 224-1114
Other practice location 4
675 N Park Ave
Pomona, CA 91768-3622
Phone (909) 868-1160
Other practice location 5
22311 Ventura Blvd Ste 116
Woodland Hills, CA 91364-1556
Phone (818) 370-4133
Other practice location 6
20914 Nordhoff St
Chatsworth, CA 91311-5934
Phone (818) 370-4133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC22891 | Other | CA | LICENSE |
Other names 1
- Mary Ellen Simone
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC22891 | CA | MD | Independent Medical Examiner Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1144597006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 W SAN BERNARDINO RD",
"city": "COVINA",
"state": "CA",
"postal_code": "917231516",
"telephone_number": "626-967-3553",
"fax_number": "626-967-1523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W SAN BERNARDINO RD",
"city": "COVINA",
"state": "CA",
"postal_code": "917231516",
"telephone_number": "626-967-3553",
"fax_number": "626-967-1523"
}
],
"practiceLocations": [
{
"address_1": "155 W Hospitality Ln Ste 105",
"address_purpose": "LOCATION",
"city": "San Bernardino",
"state": "CA",
"postal_code": "924083317",
"country_code": "US",
"telephone_number": "909-888-2210",
"fax_number": "909-885-5818",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "411 N Central Ave",
"address_purpose": "LOCATION",
"city": "Glendale",
"state": "CA",
"postal_code": "912032081",
"country_code": "US",
"telephone_number": "818-244-6792",
"fax_number": "818-244-1703",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1850 E Palmdale Blvd",
"address_purpose": "LOCATION",
"city": "Palmdale",
"state": "CA",
"postal_code": "935502026",
"country_code": "US",
"telephone_number": "661-224-1114",
"fax_number": "661-224-1119",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "675 N Park Ave",
"address_purpose": "LOCATION",
"city": "Pomona",
"state": "CA",
"postal_code": "917683622",
"country_code": "US",
"telephone_number": "909-868-1160",
"fax_number": "909-469-6086",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "22311 Ventura Blvd Ste 116",
"address_purpose": "LOCATION",
"city": "Woodland Hills",
"state": "CA",
"postal_code": "913641556",
"country_code": "US",
"telephone_number": "818-370-4133",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "20914 Nordhoff St",
"address_purpose": "LOCATION",
"city": "Chatsworth",
"state": "CA",
"postal_code": "913115934",
"country_code": "US",
"telephone_number": "818-370-4133",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIESENFARTH SIMONE",
"first_name": "MARY",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-21",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC22891",
"primary": false
},
{
"code": "111NX0100X",
"taxonomy_group": "",
"desc": "Chiropractor, Occupational Health",
"state": "CA",
"license": "DC22891",
"primary": false
},
{
"code": "111NI0013X",
"taxonomy_group": "",
"desc": "Chiropractor, Independent Medical Examiner",
"state": "CA",
"license": "DC22891",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "DC22891",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "SIMONE",
"middle_name": "ELLEN",
"credential": "D.C.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.