Active NPI
Mark A. Kimble Jr., D.C.
- Chiropractor
- Yukon, OK
National Provider Identifier
1083025670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4154
- Practice address
- 11301 W. Reno
Suite G.
Yukon, OK 73099 - Phone
- (405) 265-3920
- Fax
- (405) 265-3922
- NPI assigned
- May 16, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4154 | OK | Primary |
| Rehabilitation Chiropractor | 111NR0400X | 4154 | OK | |
| Sports Physician Chiropractor | 111NS0005X | 4154 | OK | |
| Occupational Health Chiropractor | 111NX0100X | 4154 | OK |
Addresses
Primary practice location
11301 W. Reno
Suite G.
Yukon, OK 73099
Mailing address
11301 W. Reno
Suite G.
Yukon, OK 73099
Phone (405) 265-3920
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4154 | OK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491523200000",
"number": "1083025670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11301 W. RENO",
"address_2": "SUITE G.",
"city": "YUKON",
"state": "OK",
"postal_code": "73099",
"telephone_number": "405-265-3920",
"fax_number": "405-265-3922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11301 W. RENO",
"address_2": "SUITE G.",
"city": "YUKON",
"state": "OK",
"postal_code": "73099",
"telephone_number": "405-265-3920",
"fax_number": "405-265-3922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBLE",
"first_name": "MARK",
"middle_name": "A.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-16",
"last_updated": "2017-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OK",
"license": "4154",
"primary": true
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "OK",
"license": "4154",
"primary": false
},
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "OK",
"license": "4154",
"primary": false
},
{
"code": "111NX0100X",
"taxonomy_group": "",
"desc": "Chiropractor, Occupational Health",
"state": "OK",
"license": "4154",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yukon, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.