MEDICARE: MRS. KIMBERLY NICOLE RUMACK CROWLEY 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	32133	CA
2	111N00000X	Chiropractor	DC32133	CA

General Provider Information

NPI Number	:	1801164280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY NICOLE RUMACK CROWLEY D.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 8496
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96158
Country	:	US
Telephone Number	:	530-307-2310
Fax Number	:	530-544-5306

Provider Business Practice Location Address
First Line	:	2877 LAKE TAHOE BLVD.
Second Line	:	SUITE B
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96151
Country	:	US
Telephone Number	:	530-494-3929
Fax Number	:	530-544-5306

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	01/09/2019

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