Provider Demographics
NPI:1043479801
Name:JEFFREY S. KIMBALL, D.C.
Entity Type:Organization
Organization Name:JEFFREY S. KIMBALL, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-846-4931
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:401 E. CEDAR ST
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-0888
Mailing Address - Country:US
Mailing Address - Phone:989-846-4931
Mailing Address - Fax:989-846-0350
Practice Address - Street 1:401 E. CEDAR ST.
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MICHIGAN
Practice Address - Zip Code:48658
Practice Address - Country:UM
Practice Address - Phone:989-846-4931
Practice Address - Fax:989-846-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1785412Medicaid
MI950Z650010OtherBCBSM
MI1785412Medicaid
MIT98825Medicare UPIN