Active NPI
Gabriel Kimball
- Chiropractor
- Crystal, MN
National Provider Identifier
1881387017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 7121
- Practice address
- 5600 Bass Lake Rd Ste D
Crystal, MN 55429-2722 - Phone
- (612) 529-0202
- NPI assigned
- Jun 1, 2023
- Sex
- Male
- Sole proprietor
- No
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 | 7121 | MN | Primary |
Addresses
Primary practice location
5600 Bass Lake Rd Ste D
Crystal, MN 55429-2722
Mailing address
S4337 Ledges PL
Eau Claire, WI 54701-2225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230802004174 | MN | Practitioner - Chiropractic | 1759742042 |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
5600 Bass Lake Rd
Suite D
Crystal, MN 55429-2769
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7121 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685577600000",
"number": "1881387017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "S4337 LEDGES PL",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547012225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5600 BASS LAKE RD STE D",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554292722",
"telephone_number": "612-529-0202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "GABRIEL",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-01",
"last_updated": "2023-06-01",
"certification_date": "2023-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "7121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; 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.