Individual provider Active NPI

Kjersten Jean Jones, D.C.

  • Chiropractor
  • Boise, ID
National Provider Identifier
1063782456
Registry record updated Jul 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1487 Issued in ID
Practice address
2300 S Orchard St
Ste a
Boise, ID 83705-6722
Phone
(208) 383-3703
Fax
(208) 383-3702
NPI assigned
Jan 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIA-1487 ID Primary
Chiropractor 111N00000X 5738 MN

Addresses

Primary practice location

2300 S Orchard St
Ste a
Boise, ID 83705-6722

Mailing address

2300 S Orchard St
Ste a
Boise, ID 83705-6722
Phone (208) 383-3703

Other identifiers 2

IdentifierTypeStateIssuer
350005191OtherMEDICARE
1063782456MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5738MNMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468195200000",
    "number": "1063782456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 S ORCHARD ST",
            "address_2": "STE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837056722",
            "telephone_number": "208-383-3703",
            "fax_number": "208-383-3702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 S ORCHARD ST",
            "address_2": "STE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837056722",
            "telephone_number": "208-383-3703",
            "fax_number": "208-383-3702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "KJERSTEN",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-03",
        "last_updated": "2016-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1487",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5738",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "350005191",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063782456",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.