Active NPI
Kenneth Illson, DC
- Chiropractor
- Aliso Viejo, CA
National Provider Identifier
1659554525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC17202
- Practice address
- 27 Style Dr
Aliso Viejo, CA 92656-8090 - Phone
- (949) 215-1310
- NPI assigned
- Dec 13, 2007
- 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 | DC17202 | CA | Primary |
Addresses
Primary practice location
27 Style Dr
Aliso Viejo, CA 92656-8090
Mailing address
27 Style Dr
Aliso Viejo, CA 92656-8090
Phone (949) 215-1310
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC17202 | Other | CA | STATE LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC17202 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198627200000",
"number": "1659554525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 STYLE DR",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926568090",
"telephone_number": "949-215-1310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 STYLE DR",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926568090",
"telephone_number": "949-215-1310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLSON",
"first_name": "KENNETH",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-13",
"last_updated": "2007-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC17202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "DC17202",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aliso Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.