Active NPI
Wayne Douglass Mathis, DC
- Internist Chiropractor
- Burbank,, CA
National Provider Identifier
1730255233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- DC15307
- Practice address
- 3609 W. Magnolia Blvd.
Burbank,, CA 91505 - Phone
- (818) 845-5895
- Fax
- (818) 954-8634
- NPI assigned
- Nov 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | DC15307 | CA | Primary |
Addresses
Primary practice location
3609 W. Magnolia Blvd.
Burbank,, CA 91505
Mailing address
10832 Crockett St.
Sun Valley, CA 91352
Phone (818) 768-4502
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC15307 | Other | CA | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC15307 | CA | MD | Internist Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730255233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10832 CROCKETT ST.",
"city": "SUN VALLEY",
"state": "CA",
"postal_code": "91352",
"telephone_number": "818-768-4502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3609 W. MAGNOLIA BLVD.",
"city": "BURBANK,",
"state": "CA",
"postal_code": "91505",
"telephone_number": "818-845-5895",
"fax_number": "818-954-8634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "WAYNE",
"middle_name": "DOUGLASS",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "CA",
"license": "DC15307",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "DC15307",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burbank,, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.