NPIMap

Organization Active NPI

Timothy R Twombly DC & Kenneth D Erickson DC a Chiropractic Corp

Doing business as Irvine Spine and Sport

  • Chiropractor
  • Irvine, CA
National Provider Identifier
1275696619
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
TIMOTHY R TWOMBLY DC & KENNETH D ERICKSON DC A CHIROPRACTIC CORP
Doing business as
Irvine Spine and Sport
Practice address
1110 Roosevelt
Suite# 100
Irvine, CA 92620-3686
Phone
(949) 857-1888
Fax
(949) 857-4536
NPI assigned
Dec 18, 2006
Last updated
Sep 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Authorized official

Name
Dr. Kenneth David Erickson, DCNPI 1306971601
Title
Chiropractor
Phone
(949) 857-1888

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary
Physical Therapist 225100000X

Addresses

Primary practice location

1110 Roosevelt
Suite# 100
Irvine, CA 92620-3686

Mailing address

15520 Rockfield Blvd
A220
Irvine, CA 92618-2717
Phone (949) 598-9999

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ50052ZOtherCABLUE SHIELD

Other names 1

  • Irvine Spine and Sport Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526001469 CA Part B Supplier - Clinic/Group Practice 1557342466 Receives reassigned benefits from 2 practitioners
Practice locations: Irvine, CA

National Provider Directory

National Provider Directory

Locations

1110 Roosevelt
Ste 100
Irvine, CA 92620
Phone (949) 857-1888

15520 Rockfield Blvd
Ste A220
Irvine, CA 92618

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1275696619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15520 ROCKFIELD BLVD",
            "address_2": "A220",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182717",
            "telephone_number": "949-598-9999",
            "fax_number": "949-598-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 ROOSEVELT",
            "address_2": "SUITE# 100",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926203686",
            "telephone_number": "949-857-1888",
            "fax_number": "949-857-4536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY R TWOMBLY DC & KENNETH D ERICKSON DC A CHIROPRACTIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "949-857-1888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ50052Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Irvine Spine and Sport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.