Individual provider Active NPI

Kenneth Lawrence Inchiostro

  • Chiropractor
  • Weldon Spring, MO
National Provider Identifier
1306999073
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2000172545 Issued in MO
Practice address
1043A Wolfrum Rd
Weldon Spring, MO 63304-7625
Phone
(636) 300-8089
Fax
(636) 300-8049
NPI assigned
Jan 18, 2007
Last updated
Jul 8, 2007By the provider in NPPES
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 2000172545 MO Primary

Addresses

Primary practice location

1043A Wolfrum Rd
Weldon Spring, MO 63304-7625

Mailing address

1043A Wolfrum Rd
Weldon Spring, MO 63304-7625
Phone (636) 300-8089

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050419000129 MO Practitioner - Chiropractic 2264470509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1043 A Wolfrum Rd
Weldon Spring, MO 63304-7644
Phone (636) 300-8089

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2000172545MOMDChiropractor

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": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306999073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043A WOLFRUM RD",
            "city": "WELDON SPRING",
            "state": "MO",
            "postal_code": "633047625",
            "telephone_number": "636-300-8089",
            "fax_number": "636-300-8049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043A WOLFRUM RD",
            "city": "WELDON SPRING",
            "state": "MO",
            "postal_code": "633047625",
            "telephone_number": "636-300-8089",
            "fax_number": "636-300-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INCHIOSTRO",
        "first_name": "KENNETH",
        "middle_name": "LAWRENCE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2000172545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weldon Spring, MO

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.