Healthcare Provider Details

I. General information

NPI: 1356344568
Provider Name (Legal Business Name): KIM LEE NEIBERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 NORTH WHEELING AVENUE
MUNCIE IN
47304-2042
US

IV. Provider business mailing address

3504 NORTH WHEELING AVENUE
MUNCIE IN
47304-2042
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-1777
  • Fax: 765-284-1778
Mailing address:
  • Phone: 765-284-1777
  • Fax: 765-284-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000689
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: