Active NPI
Kyle David Jepsen, D.C.
- Chiropractor
- Plymouth, MN
National Provider Identifier
1346487618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5173
- Practice address
- 4345 Nathan LN N
Ste. F
Plymouth, MN 55442-4522 - Phone
- (763) 536-1112
- Fax
- (763) 536-0471
- NPI assigned
- Jan 8, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5173 | MN | Primary |
Addresses
Primary practice location
4345 Nathan LN N
Ste. F
Plymouth, MN 55442-4522
Mailing address
4345 Nathan LN N
Ste. F
Plymouth, MN 55442-4522
Phone (763) 536-1112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5173 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231372800000",
"number": "1346487618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4345 NATHAN LN N",
"address_2": "STE. F",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554424522",
"telephone_number": "763-536-1112",
"fax_number": "763-536-0471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4345 NATHAN LN N",
"address_2": "STE. F",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554424522",
"telephone_number": "763-536-1112",
"fax_number": "763-536-0471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEPSEN",
"first_name": "KYLE",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-08",
"last_updated": "2009-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "5173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.