Healthcare Provider Details

I. General information

NPI: 1700905171
Provider Name (Legal Business Name): MICHAEL ALAN KIMMEL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 WALT WHITMAN RD
MELVILLE NY
11747-2212
US

IV. Provider business mailing address

PO BOX 1359
MELVILLE NY
11747-0308
US

V. Phone/Fax

Practice location:
  • Phone: 631-646-2256
  • Fax: 631-249-1793
Mailing address:
  • Phone: 631-249-0011
  • Fax: 631-249-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009883
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX009883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: