Healthcare Provider Details

I. General information

NPI: 1477733830
Provider Name (Legal Business Name): INFINITY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W MEEKER ST SUITE 4
KENT WA
98032-5766
US

IV. Provider business mailing address

524 W MEEKER ST SUITE 4
KENT WA
98032-5766
US

V. Phone/Fax

Practice location:
  • Phone: 253-850-9973
  • Fax: 253-850-1405
Mailing address:
  • Phone: 253-850-9973
  • Fax: 253-850-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00033987
License Number StateWA

VIII. Authorized Official

Name: DR. KIMBERLY ANN CINCILLA
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 253-850-9973