Individual provider Active NPI

Sebastian Andrew Gonzales III, D.C.

  • Chiropractor
  • Orange, CA
National Provider Identifier
1700025574
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
31137 Issued in CA
Practice address
514 W Katella Ave
Orange, CA 92867
Phone
(714) 392-6482
NPI assigned
Feb 18, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 31137 CA Primary

Addresses

Primary practice location

514 W Katella Ave
Orange, CA 92867

Mailing address

1525 Mesa Verde Dr E
Ste 108
Costa Mesa, CA 92626-5221
Phone (714) 502-4243

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200114000622 CA Practitioner - Chiropractic 2961837307 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1525 Mesa Verde Dr E
Suite 108
Costa Mesa, CA 92626-5221
Phone (714) 502-4243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31137CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sara Van Dyke Chiropractic, Inc. Chiropractor CurrentSince Apr 16, 2023 Accepting new patients
Sebastian Gonzales Chiropractic Inc. Chiropractor CurrentSince Nov 10, 2019 Accepting new patients

Locations

1525 Mesa Verde Dr E
Ste 108
Costa Mesa, CA 92626
Phone (714) 299-1192

514 W Katella Ave
Orange, CA 92867
Phone (714) 563-8478

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": "1234915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1700025574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 MESA VERDE DR E",
            "address_2": "STE 108",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265221",
            "telephone_number": "714-502-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 W KATELLA AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "92867",
            "telephone_number": "714-392-6482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "SEBASTIAN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-18",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "31137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; 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.