Phyllis Nadine Gonzales, DC, BSN-RN

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

1318 Issued in NM

Practice address

219 Washington Avenue
Santa Fe, NM 87501-1926

Phone

(505) 946-7677

Fax

(505) 986-1569

NPI assigned

Dec 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Phyllis Nadine Gonzales

  • Chiropractor
  • Santa Fe, NM
  • NPI 1609270891
  NPD (past) Authorized official

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1821150756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CAMINO ENCANTADO",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011039",
            "telephone_number": "505-946-7677",
            "fax_number": "505-986-1569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 WASHINGTON AVENUE",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011926",
            "telephone_number": "505-946-7677",
            "fax_number": "505-986-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "PHYLLIS NADINE",
        "name_prefix": "Dr.",
        "credential": "DC, BSN-RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NM",
            "license": "1318",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CO",
            "license": "4766",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "DC-29335",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "5657319",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE SYSTEM",
            "identifier": "9408737",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "12395202",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN GROUP",
            "identifier": "693017",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NM",
            "identifier": "NM00KL98",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS OREGON",
            "identifier": "876338000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Gonzales
• Mariah A Gonzales
• Melonie Gonzales, RN
• Pamela Gonzales
• Patricia Diane Gonzales, LCSW
• Richard E Gonzales, SLP
• Ruby Gonzales
• Sariah E Gonzales
• Teresita Gonzales
• Thelma Jean Gonzales

• Rehabilitation Chiropractor in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Rehabilitation Chiropractor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.