Individual provider Active NPI

Danielle Nicole Menneto, D.C.

  • Chiropractor
  • Port Orange, FL
National Provider Identifier
1659695583
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH9865 Issued in FL
Practice address
4647 Clyde Morris Blvd Unit 502
Port Orange, FL 32129-3001
Phone
(386) 202-2714
Fax
(352) 589-5549
NPI assigned
Mar 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH9865 FL Primary

Addresses

Primary practice location

4647 Clyde Morris Blvd Unit 502
Port Orange, FL 32129-3001

Mailing address

4647 Clyde Morris Blvd Unit 502
Port Orange, FL 32129-3001
Phone (386) 202-2714

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111206000637 FL Practitioner - Chiropractic 6002081817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4647 Clyde Morris Blvd
Unit 502
Port Orange, FL 32129-3001
Phone (368) 202-2714

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH9865FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Moore & Menneto Chiropractic, PLLC Chiropractor CurrentSince Sep 4, 2018 Accepting new patients
Wagner Chiropractic PA Chiropractor Past Accepting new patients

Locations

3959 S Nova Rd
Ste 9
Port Orange, FL 32127
Phone (386) 202-2714

4647 Clyde Morris Blvd
Unit 502
Port Orange, FL 32129
Phone (368) 202-2714

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1269216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1659695583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4647 CLYDE MORRIS BLVD UNIT 502",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293001",
            "telephone_number": "386-202-2714",
            "fax_number": "352-589-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4647 CLYDE MORRIS BLVD UNIT 502",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293001",
            "telephone_number": "386-202-2714",
            "fax_number": "352-589-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENNETO",
        "first_name": "DANIELLE",
        "middle_name": "NICOLE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-22",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; 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.