MEDICARE: DR. KIMBERLY IDLEBURG 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	2014018402	MO

General Provider Information

NPI Number	:	1508271131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY IDLEBURG D.C.

Provider Business Mailing Address
First Line	:	1214 E 116TH TER APT 6
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4540
Country	:	US
Telephone Number	:	636-221-2528
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E RED BRIDGE RD STE 210
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4030
Country	:	US
Telephone Number	:	816-832-8582
Fax Number	:

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	10/02/2018

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