Individual provider Active NPI

Nicole M Minatrea, D.C.

  • Chiropractor
  • Fort Worth, TX
National Provider Identifier
1700140787
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
12075 Issued in TX
Practice address
5320 Boat Club Rd
Fort Worth, TX 76135-1728
Phone
(682) 710-3126
Fax
(817) 887-2511
NPI assigned
Jun 25, 2012
Last updated
Apr 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 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 12075 TX Primary

Addresses

Primary practice location

5320 Boat Club Rd
Fort Worth, TX 76135-1728

Mailing address

5320 Boat Club Rd
Fort Worth, TX 76135-1728
Phone (682) 710-3126

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130726000596 TX Practitioner - Chiropractic 2567603939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4300 Boat Club Rd
Suite 100
Lake Worth, TX 76135-2589
Phone (682) 710-3126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12075TXMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Nicole Chiropractic and Rehab Chiropractor CurrentSince Mar 1, 2023 Accepting new patients

Locations

5320 Boat Club Rd
Fort Worth, TX 76135
Phone (682) 710-3126

4300 Boat Club Rd
Ste 100
Lake Worth, TX 76135
Phone (682) 710-3126

Organizations & group practices 1

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": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1700140787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 BOAT CLUB RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761351728",
            "telephone_number": "682-710-3126",
            "fax_number": "817-887-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 BOAT CLUB RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761351728",
            "telephone_number": "682-710-3126",
            "fax_number": "817-887-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINATREA",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-25",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "12075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.