Active NPI
Timothy Joseph Kimble, D.C., F.A.C.O.
- Chiropractor
- Lake Elsinore, CA
National Provider Identifier
1013019850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC15809
- Practice address
- 600 Central Ave Ste G
Lake Elsinore, CA 92530-2740 - Phone
- (951) 674-8711
- Fax
- (951) 674-1156
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- 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 | DC15809 | CA | Primary |
Addresses
Primary practice location
600 Central Ave Ste G
Lake Elsinore, CA 92530-2740
Mailing address
600 Central Ave Ste G
Lake Elsinore, CA 92530-2740
Phone (951) 674-8711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111229000217 | CA | Practitioner - Chiropractic | 2860668605 | Practice locations: Lake Elsinore, CA; Temecula, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
600 Central Ave
Suite G
Lake Elsinore, CA 92530-2740
Phone (951) 674-8711
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15809 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| DC15809 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1013019850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 CENTRAL AVE STE G",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925302740",
"telephone_number": "951-674-8711",
"fax_number": "951-674-1156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 CENTRAL AVE STE G",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925302740",
"telephone_number": "951-674-8711",
"fax_number": "951-674-1156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBLE",
"first_name": "TIMOTHY",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.C., F.A.C.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC15809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; 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.