MEDICARE: DR. KIMBERLY ANN EMBRY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	001470	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050001470CT01	OTHER	CT	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1588785356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN EMBRY DC

Provider Business Mailing Address
First Line	:	301 CROSS HILL RD
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-2706
Country	:	US
Telephone Number	:	203-268-6608
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 ELM ST
Second Line	:	STE 204-A
City	:	MONROE
State	:	CT
Zip	:	06468-2280
Country	:	US
Telephone Number	:	203-268-6608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. KIMBERLY ANN EMBRY DC” Practice Location

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