Healthcare Provider Details

I. General information

NPI: 1366232100
Provider Name (Legal Business Name): MICHELLE KIMN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 COIT RD STE 100
PLANO TX
75075-3767
US

IV. Provider business mailing address

1005 DAME CAROL WAY
CARROLLTON TX
75010-2357
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-7345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: