Individual provider Active NPI

Matthew Brian Weintraub, D.C.

  • Chiropractor
  • Charleston, SC
National Provider Identifier
1487106654
Registry record updated Jun 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.013020 Issued in IL
Practice address
705 Saint Andrews Blvd Ste B
Charleston, SC 29407-7342
Phone
(516) 244-2622
NPI assigned
Nov 3, 2016
Last updated
Jun 16, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.013020 IL Primary

Addresses

Primary practice location

705 Saint Andrews Blvd Ste B
Charleston, SC 29407-7342

Mailing address

5 Rosedale Dr
Charleston, SC 29407-7256
Phone (516) 244-2622

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180907001087 SC Practitioner - Chiropractic 9537449640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

705 Saint Andrews Blvd
Suite B
Charleston, SC 29407-7342
Phone (516) 244-2622

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.013020ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Spine-Pain Center, LLC Chiropractor CurrentSince Jun 11, 2018 Accepting new patients
Homeo LLC Chiropractor CurrentSince Aug 1, 2021 Accepting new patients

Locations

705 Saint Andrews Blvd
Ste B
Charleston, SC 29407
Phone (516) 244-2622

5633 Rivers Ave
North Charleston, SC 29406
Phone (843) 606-2412

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1487106654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ROSEDALE DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077256",
            "telephone_number": "516-244-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 SAINT ANDREWS BLVD STE B",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077342",
            "telephone_number": "516-244-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINTRAUB",
        "first_name": "MATTHEW",
        "middle_name": "BRIAN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-03",
        "last_updated": "2023-06-16",
        "certification_date": "2020-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.013020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; 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.