Individual provider Active NPI

Kurt A Johnson

  • Chiropractor
  • Lake Forest, CA
National Provider Identifier
1891856688
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC17212 Issued in CA
Practice address
20671 Lake Forest Dr Ste B102
Lake Forest, CA 92630-7746
Phone
(949) 587-9990
Fax
(949) 587-0485
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC17212 CA Primary

Addresses

Primary practice location

20671 Lake Forest Dr Ste B102
Lake Forest, CA 92630-7746

Mailing address

20671 Lake Forest Dr Ste B102
Lake Forest, CA 92630-7746
Phone (949) 587-9990

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090202000603 IA Practitioner - Chiropractic 1658274568 Practice locations: Delhi, IA; Manchester, IA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

608 E Main St
Manchester, IA 52057-1841
Phone (563) 927-2555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05047IAMDAddiction (Substance Use Disorder) Counselor
DC17212CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Christian Chee Chiropractic Inc Chiropractor PastSince Apr 11, 2012 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891856688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20671 LAKE FOREST DR STE B102",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307746",
            "telephone_number": "949-587-9990",
            "fax_number": "949-587-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20671 LAKE FOREST DR STE B102",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307746",
            "telephone_number": "949-587-9990",
            "fax_number": "949-587-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KURT",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC17212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, 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.

Verify at the official NPI Registry.