Healthcare Provider Details

I. General information

NPI: 1679672786
Provider Name (Legal Business Name): JEFFREY S KIMBALL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CEDAR ST
STANDISH MI
48658-9620
US

IV. Provider business mailing address

401 E CEDAR ST PO BOX 888
STANDISH MI
48658-9620
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-4931
  • Fax: 989-846-0350
Mailing address:
  • Phone: 989-846-4931
  • Fax: 989-846-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: