NPIMap

Organization Active NPI

Kaikoa LLC

Doing business as Freeform Chiropractic

  • Chiropractor
  • Fort Worth, TX
National Provider Identifier
1023468485
Registry record updated Jun 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
12301 Issued in TX
Legal business name
KAIKOA LLC
Doing business as
Freeform Chiropractic
Practice address
4525 Heritage Trace Pkwy
Suite 101
Fort Worth, TX 76244-8908
Phone
(817) 431-5100
Fax
(817) 887-3008
NPI assigned
Jun 16, 2016
Last updated
Jun 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2016

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

Authorized official

Name
Dr. Jesse Jacobs, D.C.NPI 1114356466
Title
Owner
Phone
(214) 636-6906

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 12301 TX Primary

Addresses

Primary practice location

4525 Heritage Trace Pkwy
Suite 101
Fort Worth, TX 76244-8908

Mailing address

4525 Heritage Trace Pkwy
Suite 101
Fort Worth, TX 76244-8908
Phone (817) 431-5100

Other names 1

  • Freeform Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160901000225 TX Part B Supplier - Clinic/Group Practice 3173819083 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1023468485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 HERITAGE TRACE PKWY",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762448908",
            "telephone_number": "817-431-5100",
            "fax_number": "817-887-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 HERITAGE TRACE PKWY",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762448908",
            "telephone_number": "817-431-5100",
            "fax_number": "817-887-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAIKOA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-636-6906",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "12301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freeform Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; 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.