Samuel Newsome

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

36083 Issued in CA

Practice address

135 Rio Robles E Unit 165
San Jose, CA 95134-1682

Phone

(626) 731-5459

NPI assigned

Jun 7, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1467981035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 N AZUSA AVE",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917023439",
            "telephone_number": "626-731-5459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 RIO ROBLES E UNIT 165",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951341682",
            "telephone_number": "626-731-5459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWSOME",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2022-07-21",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "2000025544",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "36083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "15421277",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.