Active NPI
Dirk H Kancilia, DC
- Chiropractor
- San Diego, CA
National Provider Identifier
1477797579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC16440
- Practice address
- 16980 Via Tazon
160
San Diego, CA 92127-1633 - Phone
- (858) 345-4114
- Fax
- (858) 679-8411
- NPI assigned
- Apr 21, 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 | DC16440 | CA | Primary |
Addresses
Primary practice location
16980 Via Tazon
160
San Diego, CA 92127-1633
Mailing address
33175 Temecula Pkwy
A125
Temecula, CA 92592-7300
Phone (858) 345-4114
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 |
|---|---|---|---|
| DC16440 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ejd Medical Corporation | Past | Accepting new patients |
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": "1240272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285891200000",
"number": "1477797579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33175 TEMECULA PKWY",
"address_2": "A125",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925927300",
"telephone_number": "858-345-4114",
"fax_number": "866-920-8576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16980 VIA TAZON",
"address_2": "160",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921271633",
"telephone_number": "858-345-4114",
"fax_number": "858-679-8411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANCILIA",
"first_name": "DIRK",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-21",
"last_updated": "2010-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC16440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.