Individual provider Active NPI

Kenneth Scott Kandler, D.C.

  • Chiropractor
  • Stinson Beach, CA
National Provider Identifier
1174609192
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC25152 Issued in CA
Practice address
3425 Highway 1
Stinson Beach, CA 94970
Phone
(415) 868-1370
Fax
(415) 868-9520
NPI assigned
Oct 31, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 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 DC25152 CA Primary

Addresses

Primary practice location

3425 Highway 1
Stinson Beach, CA 94970

Mailing address

3425 State Route 1
PO Box 267
Stinson Beach, CA 94970-0267
Phone (415) 868-1370

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240417003512 CA Practitioner - Chiropractic 9638518095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 1996
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

224 A Weller St
Petaluma, CA 94952-3410

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC25152CAMDChiropractor

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1174609192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 STATE ROUTE 1",
            "address_2": "PO BOX 267",
            "city": "STINSON BEACH",
            "state": "CA",
            "postal_code": "949700267",
            "telephone_number": "415-868-1370",
            "fax_number": "415-868-9520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 HIGHWAY 1",
            "city": "STINSON BEACH",
            "state": "CA",
            "postal_code": "94970",
            "telephone_number": "415-868-1370",
            "fax_number": "415-868-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDLER",
        "first_name": "KENNETH",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC25152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stinson Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.