Active NPI
Kimberly Suzanne Jackson, DC
- Chiropractor
- Ann Arbor, MI
National Provider Identifier
1972543189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2301005827
- Practice address
- 4825 Ann Arbor Saline Rd
Ann Arbor, MI 48103-9782 - Phone
- (734) 930-6990
- Fax
- (734) 327-1050
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- 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 | 2301005827 | MI | Primary |
Addresses
Primary practice location
4825 Ann Arbor Saline Rd
Ann Arbor, MI 48103-9782
Mailing address
4825 Ann Arbor Saline Rd
Ann Arbor, MI 48103-9782
Phone (734) 930-6990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 950H150320 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101215001207 | MI | Practitioner - Chiropractic | 0042408155 | Practice locations: Ann Arbor, MI |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389830400000",
"number": "1972543189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4825 ANN ARBOR SALINE RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481039782",
"telephone_number": "734-930-6990",
"fax_number": "734-327-1050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4825 ANN ARBOR SALINE RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481039782",
"telephone_number": "734-930-6990",
"fax_number": "734-327-1050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIMBERLY",
"middle_name": "SUZANNE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2014-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "2301005827",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "950H150320",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.