Individual provider Active NPI

Valerie Marie Fantino, DC

  • Chiropractor
  • Charleston, SC
National Provider Identifier
1700848959
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1009 Issued in SC
Practice address
1001-A Physicians Dr.
Charleston, SC 29414
Phone
(843) 571-1020
Fax
(843) 573-0788
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1009 SC Primary

Addresses

Primary practice location

1001-A Physicians Dr.
Charleston, SC 29414

Mailing address

1001-A Physicians Dr.
Charleston, SC 29414
Phone (843) 571-1020

Other identifiers 1

IdentifierTypeStateIssuer
GCH363MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120130000970 SC Practitioner - Chiropractic 6002717873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 1981
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1001 A Physicians Dr
Charleston, SC 29414-5746
Phone (843) 571-1020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1009SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellnessplus P a Chiropractor CurrentSince Jun 20, 1991 Accepting new patients

Locations

1001 Physicians Dr
#A
Charleston, SC 29414
Phone (843) 571-1020

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1700848959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001-A PHYSICIANS DR.",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29414",
            "telephone_number": "843-571-1020",
            "fax_number": "843-573-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001-A PHYSICIANS DR.",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29414",
            "telephone_number": "843-571-1020",
            "fax_number": "843-573-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTINO",
        "first_name": "VALERIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "1009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GCH363",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; 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.