Individual provider Active NPI

Michael Daniel Villanueva, D.C.

  • Chiropractor
  • Redlands, CA
National Provider Identifier
1891429577
Registry record updated Jul 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC36382 Issued in CA
Practice address
620 Alabama St
Redlands, CA 92373-8059
Phone
(909) 792-4434
Fax
(909) 335-1139
NPI assigned
Jul 10, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC36382 CA Primary

Addresses

Primary practice location

620 Alabama St
Redlands, CA 92373-8059

Mailing address

688 Cypress Ave
Colton, CA 92324-1952
Phone (909) 554-0774

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220904000110 CA Practitioner - Chiropractic 3577947894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phillips-White Chiropractic CorporationGroup PAC ID 7719170687, 9 clinicians

Practice addresses (Care Compare)

620 Alabama St
Redlands, CA 92373-8059
Phone (909) 792-4434

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC36382CAMDChiropractor

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1657411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657411200000",
    "number": "1891429577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 CYPRESS AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241952",
            "telephone_number": "909-554-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 ALABAMA ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738059",
            "telephone_number": "909-792-4434",
            "fax_number": "909-335-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLANUEVA",
        "first_name": "MICHAEL",
        "middle_name": "DANIEL",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-10",
        "last_updated": "2022-07-10",
        "certification_date": "2022-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC36382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2022; 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.