Healthcare Provider Details

I. General information

NPI: 1902138027
Provider Name (Legal Business Name): KIMBERLY JEAN ZURICH ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MAIN ST SUITE 212
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

650 MAIN ST SUITE 212
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-210-2388
  • Fax:
Mailing address:
  • Phone: 207-210-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP346
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC531
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: