Individual provider Active NPI

Kenneth D Erickson, D.C.

  • Chiropractor
  • Irvine, CA
National Provider Identifier
1306971601
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
25690 Issued in CA
Practice address
14150 Culver Dr
Suite# 103
Irvine, CA 92604-0315
Phone
(949) 857-1888
Fax
(949) 857-4536
NPI assigned
Feb 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 25690 CA Primary

Addresses

Primary practice location

14150 Culver Dr
Suite# 103
Irvine, CA 92604-0315

Mailing address

15520 Rockfield Blvd
Ste A200
Irvine, CA 92618-6705
Phone (949) 598-9999

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ50052ZOtherCABLUE SHIELD
DC25690OtherCADC LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110208000341 CA Practitioner - Chiropractic 2567518590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1110 Roosevelt
Suite 100
Irvine, CA 92620-3684
Phone (949) 857-1888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25690CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Timothy R Twombly DC & Kenneth D Erickson DC a Chiropractic Corp Chiropractor CurrentSince Dec 3, 2002 Accepting new patients

Locations

15520 Rockfield Blvd
Ste A200
Irvine, CA 92618

14150 Culver Dr
Ste 103
Irvine, CA 92604
Phone (949) 262-9142

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1306971601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15520 ROCKFIELD BLVD",
            "address_2": "STE A200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926186705",
            "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": "14150 CULVER DR",
            "address_2": "SUITE# 103",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926040315",
            "telephone_number": "949-857-1888",
            "fax_number": "949-857-4536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "KENNETH",
        "middle_name": "D",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "25690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ50052Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DC LICENSE",
            "identifier": "DC25690",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 17, 2018; 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.