Active NPI
Kathryn M Phelan, DOCTOR OF CHIROPRACT
- Chiropractor
- Grover Beach, CA
National Provider Identifier
1548272925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC21777
- Practice address
- 575 S 4TH St
Grover Beach, CA 93433-1953 - Phone
- (805) 473-8895
- NPI assigned
- Aug 13, 2006
- Sex
- Female
- 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 | DC21777 | CA | Primary |
Addresses
Primary practice location
575 S 4TH St
Grover Beach, CA 93433-1953
Mailing address
575 S 4TH St
Grover Beach, CA 93433-1953
Phone (805) 473-8895
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC21777 | Other | CA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120425000063 | CA | Practitioner - Chiropractic | 2163684937 | Practice locations: Grover Beach, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1990
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
575 S 4TH St
Grover Beach, CA 94343-1905
Phone (805) 473-8895
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC21777 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548272925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "575 S 4TH ST",
"city": "GROVER BEACH",
"state": "CA",
"postal_code": "934331953",
"telephone_number": "805-473-8895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 S 4TH ST",
"city": "GROVER BEACH",
"state": "CA",
"postal_code": "934331953",
"telephone_number": "805-473-8895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "KATHRYN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DOCTOR OF CHIROPRACT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC21777",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "DC21777",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grover Beach, CA
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.