Individual provider Active NPI

Jeffery William Kirkland, D.C.

  • Chiropractor
  • Tyler, TX
National Provider Identifier
1699306969
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
14339 Issued in TX
Practice address
6004 S Broadway Ave Ste 200
Tyler, TX 75703-4424
Phone
(903) 534-7095
Fax
(903) 534-7094
NPI assigned
Jan 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 14339 TX Primary

Addresses

Primary practice location

6004 S Broadway Ave Ste 200
Tyler, TX 75703-4424

Mailing address

10628 State Highway 19 S
Athens, TX 75751-5597
Phone (903) 286-2095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240318003388 TX Practitioner - Chiropractic 1052758737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6004 S Broadway Ave
Suite 200
Tyler, TX 75703-4424
Phone (903) 534-7095

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kirkland Chiropractic LLC Chiropractor CurrentSince Feb 1, 2024 Accepting new patients
Santo Chiropractic Neurology Center, Inc. Chiropractor PastSince Feb 2, 2020 Accepting new patients

Locations

6004 S Broadway Ave
Ste 200
Tyler, TX 75703
Phone (903) 534-7095

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580083200000",
    "number": "1699306969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10628 STATE HIGHWAY 19 S",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757515597",
            "telephone_number": "903-286-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6004 S BROADWAY AVE STE 200",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034424",
            "telephone_number": "903-534-7095",
            "fax_number": "903-534-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKLAND",
        "first_name": "JEFFERY",
        "middle_name": "WILLIAM",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-27",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "14339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.

Verify at the official NPI Registry.