Individual provider Active NPI

Kim M Sanders, D.C.

  • Chiropractor
  • Jacksonville, FL
National Provider Identifier
1336152974
Registry record updated Jan 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH8174 Issued in FL
Practice address
7545 Centurion Pkwy
Suite 205
Jacksonville, FL 32256-0579
Phone
(904) 744-4100
Fax
(904) 744-4210
NPI assigned
Aug 14, 2006
Last updated
Jan 26, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH8174 FL Primary

Addresses

Primary practice location

7545 Centurion Pkwy
Suite 205
Jacksonville, FL 32256-0579

Mailing address

7545 Centurion Pkwy
Suite 205
Jacksonville, FL 32256-0579
Phone (904) 744-4100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110405000395 FL Practitioner - Chiropractic 8820272560

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH8174FLMDChiropractor

Interoperability endpoints

  • Direct secure messaging: drkim@sc0075.direct.chirotouch.md

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296000000000",
    "number": "1336152974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7545 CENTURION PKWY",
            "address_2": "SUITE 205",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560579",
            "telephone_number": "904-744-4100",
            "fax_number": "904-744-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7545 CENTURION PKWY",
            "address_2": "SUITE 205",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560579",
            "telephone_number": "904-744-4100",
            "fax_number": "904-744-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "KIM",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2011-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; 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.