Individual provider Active NPI

Everardo Camacho, DC

  • Chiropractor
  • Simi Valley, CA
National Provider Identifier
1659061265
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
36562 Issued in CA
Practice address
1424 Madera Rd
Simi Valley, CA 93065-3053
Phone
(805) 522-5722
Fax
(805) 915-4141
NPI assigned
May 9, 2023
Last updated
Sep 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 36562 CA Primary

Addresses

Primary practice location

1424 Madera Rd
Simi Valley, CA 93065-3053

Mailing address

1040 Flynn Rd
Camarillo, CA 93012-5092
Phone (805) 673-3930

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250922003195 CA Practitioner - Chiropractic 4688179682 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1040 Flynn Rd
Camarillo, CA 93012-5092

1315 S Grand Ave
Suite 202
Glendora, CA 91740-5053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36562CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Clinicas del Camino Real Inc CurrentSince Sep 22, 2025 Accepting new patients
Lifestyle Chiropractic & Sports Performance, a Camacho Corp. Chiropractor CurrentSince May 14, 2023 Accepting new patients
Clinicas del Camino Real Inc CurrentSince Sep 22, 2025 Accepting new patients
Clinicas del Camino Real Inc Current Accepting new patients

Locations

2079 S Atlantic Blvd
Ste D
Monterey Park, CA 91754
Phone (626) 602-6138

500 E Main St
Santa Paula, CA 93060
Phone (805) 933-0895

1424 Madera Rd
Simi Valley, CA 93065
Phone (805) 522-5722

Interoperability endpoints

  • Direct secure messaging: ecamacho834537@direct.ochin.org

Organizations & group practices 4

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": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1659061265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125092",
            "telephone_number": "805-673-3930",
            "fax_number": "805-659-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 MADERA RD",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930653053",
            "telephone_number": "805-522-5722",
            "fax_number": "805-915-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "EVERARDO",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-09",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "36562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; 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.