Individual provider Active NPI

Selina Suliveres, DC

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1215633755
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR010769 Issued in GA
Practice address
1355 Roswell Rd Ste 152
Marietta, GA 30062-9058
Phone
(678) 809-0154
NPI assigned
Feb 6, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR010769 GA Primary

Addresses

Primary practice location

1355 Roswell Rd Ste 152
Marietta, GA 30062-9058

Mailing address

1355 Roswell Rd Ste 152
Marietta, GA 30062-9058
Phone (678) 809-0154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230310000673 GA Practitioner - Chiropractic 3476926510 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR010769GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Brian Gillis P C Chiropractor CurrentSince Feb 20, 2023 Accepting new patients
Perry Chiropractic of Warner Robins, LLC Chiropractor PastSince Aug 11, 2019 Accepting new patients

Locations

1207 Main St
Ste C
Perry, GA 31069
Phone (478) 987-9666

Organizations & group practices 3

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": "1675641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1215633755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 ROSWELL RD STE 152",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300629058",
            "telephone_number": "678-809-0154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 ROSWELL RD STE 152",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300629058",
            "telephone_number": "678-809-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULIVERES",
        "first_name": "SELINA",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-06",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR010769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.