MEDICARE: DR. MICHELE GENENE KIMEL 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	7857	AZ

General Provider Information

NPI Number	:	1629264700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE GENENE KIMEL D.C.

Provider Business Mailing Address
First Line	:	17250 NORTH 43RD AVENUE
Second Line	:	SUITE 3
City	:	GLENDALE
State	:	AZ
Zip	:	85308-4024
Country	:	US
Telephone Number	:	602-993-1722
Fax Number	:	602-428-6975

Provider Business Practice Location Address
First Line	:	13615 N 35TH AVE STE 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-1243
Country	:	US
Telephone Number	:	602-993-1722
Fax Number	:	602-866-0219

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

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	05/06/2019

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