Charles Fagenholz, DC

Primary specialty

Independent Medical Examiner ChiropractorTaxonomy code 111NI0013X

License

33312 Issued in CA

Practice address

3151 Airway Ave
U-3
Costa Mesa, CA 92626-4607

Phone

(714) 754-8008

NPI assigned

May 9, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Cohn Chiropractic Group, Inc

  • Chiropractor
  • Costa Mesa, CA
  • NPI 1073793428
  NPD (past)

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1841646809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21264 BEACH BLVD",
            "address_2": "#203",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926485482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE",
            "address_2": "U-3",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264607",
            "telephone_number": "714-754-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGENHOLZ",
        "first_name": "CHARLES",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NI0013X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Independent Medical Examiner",
            "state": "CA",
            "license": "33312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evergreen Congregate, LLC
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• Rowenda Facundo
• Patrick Faga
• La Keisha Fairbee
• Karla Daniela Fajardo Vazquez
• Family Dental
• Family First Icare, Inc.
• Natalie Ting-Chia Fan

• Independent Medical Examiner Chiropractor in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Independent Medical Examiner Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; 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.