NPIMap

Organization Active NPI

Gulfside Chiropractic Health Center

  • Chiropractor
  • Bonita Springs, FL
National Provider Identifier
1295268910
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH 12155 Issued in FL
Legal business name
GULFSIDE CHIROPRACTIC HEALTH CENTER
Practice address
9138 Bonita Beach Rd SE
Bonita Springs, FL 34135-4291
Phone
(239) 908-9762
NPI assigned
Apr 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Authorized official

Name
Dr. Kreg Dale Sherman II, D.C.NPI 1598299497
Title
Managing Partner
Phone
(239) 908-9762

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH 12155 FL Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH12151 FL

Addresses

Primary practice location

9138 Bonita Beach Rd SE
Bonita Springs, FL 34135-4291

Mailing address

9138 Bonita Beach Rd SE
Bonita Springs, FL 34135-4291
Phone (239) 908-9762

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170613002144 FL Part B Supplier - Clinic/Group Practice 3274801345 Receives reassigned benefits from 4 practitioners
Practice locations: Fort Myers, FL; Bonita Springs, FL

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1295268910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9138 BONITA BEACH RD SE",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354291",
            "telephone_number": "239-908-9762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9138 BONITA BEACH RD SE",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354291",
            "telephone_number": "239-908-9762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFSIDE CHIROPRACTIC HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "KREG",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "239-908-9762",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 12155",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH12151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.