Individual provider Active NPI

John Joseph Kicos, D.C.

  • Chiropractor
  • Cornelius, NC
National Provider Identifier
1104905496
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2396 Issued in NC
Practice address
19810 W Catawba Ave
Cornelius, NC 28031-4056
Phone
(704) 895-3203
Fax
(704) 895-3204
NPI assigned
Nov 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2396 NC Primary

Addresses

Primary practice location

19810 W Catawba Ave
Cornelius, NC 28031-4056

Mailing address

19810 W Catawba Ave
Cornelius, NC 28031-4056
Phone (704) 895-3203

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120504000613 NC Practitioner - Chiropractic 4385806504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

19810 W Catawba Ave
Suite B
Cornelius, NC 28031-4057
Phone (704) 895-3203

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2396NCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kicos Chiropractic Inc CurrentSince May 17, 2001 Accepting new patients
Kicos Chiropractic, Inc. Chiropractor CurrentSince May 17, 2001 Accepting new patients

Locations

19810 W Catawba Ave
Cornelius, NC 28031
Phone (704) 895-3203

19810 W Catawba Ave
Ste B
Cornelius, NC 28031
Phone (704) 895-3203

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104905496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19810 W CATAWBA AVE",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314056",
            "telephone_number": "704-895-3203",
            "fax_number": "704-895-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19810 W CATAWBA AVE",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314056",
            "telephone_number": "704-895-3203",
            "fax_number": "704-895-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KICOS",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.