Phyllis Nadine Gonzales

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1318 Issued in NM

Legal business name

PHYLLIS NADINE GONZALES

Practice address

219 Washington Ave
Santa Fe, NM 87501-1926

Phone

(505) 946-7677

Fax

(505) 986-1569

NPI assigned

Oct 16, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Phyllis Nadine Gonzales, DC, BSN-RNNPI 1821150756

Title

Owner

Phone

(505) 946-7677

Specialties & licenses 1

Addresses

Other identifiers 9

Other names 1

• Universal Chiropractic Dr. P.Nadine Gonzales, LLC Doing business as

Locations

Practitioners 1

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

• Phyllis Nadine Gonzales, DC, BSN-RN

  • Rehabilitation Chiropractor
  • Santa Fe, NM
  • NPI 1821150756
  NPD (past) Authorized official

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

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1609270891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CAMINO ENCANTADO",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011039",
            "telephone_number": "505-946-7677",
            "fax_number": "505-986-1569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 WASHINGTON AVE",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011926",
            "telephone_number": "505-946-7677",
            "fax_number": "505-986-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYLLIS NADINE GONZALES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-16",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "PHYLLIS NADINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-946-7677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, BSN-RN"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NM",
            "license": "1318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE SYSTEM",
            "identifier": "9408737",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NM",
            "identifier": "NM00KL98",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "12395202",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NUCC TAXONOMY",
            "identifier": "11NR0400X",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1821150756",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS OREGON",
            "identifier": "876338000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "5657319",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12248763",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN GROUP",
            "identifier": "693017",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Universal Chiropractic Dr. P.Nadine Gonzales, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Santa Fe, NM
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• Chiropractor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.