Organization Active NPI

Mendyk Chiropractic, Inc

  • Chiropractor
  • Perris, CA
National Provider Identifier
1972622280
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC18538 Issued in CA
Legal business name
MENDYK CHIROPRACTIC, INC
Practice address
1688 N Perris Blvd Ste G2
Perris, CA 92571-4744
Phone
(951) 943-1722
Fax
(951) 943-3133
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Damaris Mendyk
Title
Office Manager
Phone
(951) 697-1246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC18538 CA Primary

Addresses

Primary practice location

1688 N Perris Blvd Ste G2
Perris, CA 92571-4744

Mailing address

1688 N Perris Blvd Ste G2
Perris, CA 92571-4744
Phone (951) 943-1722

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141113001541 CA Part B Supplier - Clinic/Group Practice 8224250949 Receives reassigned benefits from 2 practitioners
Practice locations: Perris, CA

National Provider Directory

National Provider Directory

Locations

126 Avocado Ave
Ste 203
Perris, CA 92571
Phone (951) 894-1646

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972622280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1688 N PERRIS BLVD STE G2",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925714744",
            "telephone_number": "951-943-1722",
            "fax_number": "951-943-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1688 N PERRIS BLVD STE G2",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925714744",
            "telephone_number": "951-943-1722",
            "fax_number": "951-943-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDYK CHIROPRACTIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MENDYK",
        "authorized_official_first_name": "DAMARIS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "951-697-1246",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC18538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.