Healthcare Provider Details

I. General information

NPI: 1841697984
Provider Name (Legal Business Name): JAMIE KIMBALL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 SPOKANE AVE STE 4
WHITEFISH MT
59937-2980
US

IV. Provider business mailing address

903 SPOKANE AVE STE 4
WHITEFISH MT
59937-2980
US

V. Phone/Fax

Practice location:
  • Phone: 406-405-0521
  • Fax:
Mailing address:
  • Phone: 406-405-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number169623
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: