Marvin Icban Bautista, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC28034 Issued in CA

Practice address

931 San Bruno Ave W RM 7
San Bruno, CA 94066-3435

Phone

(650) 225-0500

Fax

(650) 225-0510

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 2001

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bautista Chiropractic Care Inc

  • Chiropractor
  • San Bruno, CA
  • NPI 1174662530
  Medicare reassignment NPD
• Aranibar Chiropractic Care, Inc

  • Chiropractor
  • San Bruno, CA
  • NPI 1629358007
  NPD (past)
• Mills-Peninsula Health Services

  • General Acute Care Hospital
  • Burlingame, CA
  • NPI 1518937051
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215012778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 YOLO CT",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940662555",
            "telephone_number": "650-892-3669",
            "fax_number": "650-225-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 SAN BRUNO AVE W RM 7",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940663435",
            "telephone_number": "650-225-0500",
            "fax_number": "650-225-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "MARVIN",
        "middle_name": "ICBAN",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC28034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Batty
• Bautista Chiropractic Care Inc
• Jade Bautista, PHARMD
• Kyle Anthony Bautista
• Marcelina Bautista
• Bay Area PL Services
• Bay Area PL Services
• Bayhill Acupuncture Health Center, Inc
• Kristina Marie Becker
• Madelline Beckham

• Chiropractor in San Bruno, CA
• Providers in San Bruno, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.