Individual provider Active NPI

Nicole Allison Stewart, DC

  • Chiropractor
  • Valrico, FL
National Provider Identifier
1487121307
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH12627 Issued in FL
Practice address
1548 Bloomingdale Ave
Valrico, FL 33596-6101
Phone
(813) 946-6283
Fax
(813) 322-2508
NPI assigned
Oct 29, 2018
Last updated
Apr 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 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 CH12627 FL Primary

Addresses

Primary practice location

1548 Bloomingdale Ave
Valrico, FL 33596-6101

Mailing address

1548 Bloomingdale Ave
Valrico, FL 33596-6101
Phone (813) 946-6283

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200113001298 FL Practitioner - Chiropractic 7113945510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH12627FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
CRHG, LLC CurrentSince Apr 1, 2023 Accepting new patients

Locations

1548 Bloomingdale Ave
Valrico, FL 33596
Phone (813) 702-3559

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": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1487121307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1548 BLOOMINGDALE AVE",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335966101",
            "telephone_number": "813-946-6283",
            "fax_number": "813-322-2508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1548 BLOOMINGDALE AVE",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335966101",
            "telephone_number": "813-946-6283",
            "fax_number": "813-322-2508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "NICOLE",
        "middle_name": "ALLISON",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-29",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH12627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valrico, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.