Kimberly Lynn Mercer Etheredge, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH8053 Issued in FL

Practice address

4711 N Dixie Hwy Ste a
Oakland Park, FL 33334-3916

Phone

(954) 491-8127

Fax

(954) 491-2388

NPI assigned

Oct 6, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kimberly Lynn Etheredge Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

John C Theeck D.C., P.a.Group PAC ID 8729110291, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• John C Theeck DC PA

  dba Legacy Clinic of Chiropractic

  • Chiropractor
  • The Villages, FL
  • NPI 1033430921
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206316800000",
    "number": "1912094392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 N DIXIE HWY STE A",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333343916",
            "telephone_number": "954-491-8127",
            "fax_number": "954-491-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 N DIXIE HWY STE A",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333343916",
            "telephone_number": "954-491-8127",
            "fax_number": "954-491-2388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERCER ETHEREDGE",
        "first_name": "KIMBERLY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ETHEREDGE",
            "middle_name": "LYNN",
            "prefix": "DR.",
            "credential": "D.C.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Michael F Petrie DC PA (Petrie Chiropractic Life Center)

• Chiropractor in Oakland Park, FL
• Providers in Oakland Park, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; 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.