Provider Demographics
NPI:1033627369
Name:JIMENEZ, KATHERINE (DC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CLYDE MORRIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8172
Mailing Address - Country:US
Mailing Address - Phone:386-672-3305
Mailing Address - Fax:
Practice Address - Street 1:1417 N SEMORAN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3555
Practice Address - Country:US
Practice Address - Phone:407-900-7264
Practice Address - Fax:407-674-7322
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor