Back in Motion Chiropractic Kristin Bodenbender, D.C., Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC24289 Issued in CA

Legal business name

BACK IN MOTION CHIROPRACTIC KRISTIN BODENBENDER, D.C., INC.

Practice address

2850 Mesa Verde Dr E
Suite K
Costa Mesa, CA 92626-4891

Phone

(714) 434-2585

Fax

(866) 390-2850

NPI assigned

May 19, 2010

Organization subpart

No

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

Authorized official

Name

Kristin M Bodenbender, D.C.

Title

Owner / Provider

Phone

(714) 434-2585

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Back In Motion, Inc. Former legal business name

Locations

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1437478237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 MESA VERDE DR E",
            "address_2": "SUITE K",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264891",
            "telephone_number": "714-434-2585",
            "fax_number": "866-390-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 MESA VERDE DR E",
            "address_2": "SUITE K",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264891",
            "telephone_number": "714-434-2585",
            "fax_number": "866-390-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK IN MOTION CHIROPRACTIC KRISTIN BODENBENDER, D.C., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "BODENBENDER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER / PROVIDER",
        "authorized_official_telephone_number": "714-434-2585",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC24289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM",
            "identifier": "676426",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1770781213",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "DC24289",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ66768Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back In Motion, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Chiropractor in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.