Active NPI
Charlene Phyllis Monticello, D.C.
- Chiropractor
- Santa Rosa, CA
National Provider Identifier
1962615021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC27131
- Practice address
- 269 Aviation Blvd
Ste 102
Santa Rosa, CA 95403-9017 - Phone
- (707) 836-1333
- NPI assigned
- May 7, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC27131 | CA | Primary |
Addresses
Primary practice location
269 Aviation Blvd
Ste 102
Santa Rosa, CA 95403-9017
Mailing address
269 Aviation Blvd., Ste. 102
Windsor, CA 95492-9540
Phone (707) 836-1333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050323000881 | CA | Practitioner - Chiropractic | 2668428624 | Practice locations: Santa Rosa, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - West Sunnyvale, 1999
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
269 Aviation Blvd
Suite 102
Santa Rosa, CA 95403-9017
Phone (707) 836-1333
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC27131 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461196800000",
"number": "1962615021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 AVIATION BLVD., STE. 102",
"city": "WINDSOR",
"state": "CA",
"postal_code": "954929540",
"telephone_number": "707-836-1333",
"fax_number": "707-838-4382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 AVIATION BLVD",
"address_2": "STE 102",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954039017",
"telephone_number": "707-836-1333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTICELLO",
"first_name": "CHARLENE",
"middle_name": "PHYLLIS",
"name_prefix": "Mrs.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2016-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC27131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.