Healthcare Provider Details

I. General information

NPI: 1508271131
Provider Name (Legal Business Name): KIMBERLY IDLEBURG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E RED BRIDGE RD STE 210
KANSAS CITY MO
64131-4030
US

IV. Provider business mailing address

1214 E 116TH TER APT 6
KANSAS CITY MO
64131-4540
US

V. Phone/Fax

Practice location:
  • Phone: 816-832-8582
  • Fax:
Mailing address:
  • Phone: 636-221-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2014018402
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: