MEDICARE: KIMBERLY DIANE OGLETREE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2224	AL

General Provider Information

NPI Number	:	1023282522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DIANE OGLETREE D.C.

Provider Business Mailing Address
First Line	:	3969 JOHNSTOWN DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2342
Country	:	US
Telephone Number	:	334-333-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 LOMAC ST
Second Line	:	STE AOA
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2945
Country	:	US
Telephone Number	:	334-333-5979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/20/2021

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