Provider Demographics
NPI:1053647180
Name:JEFFERSON, KIMBERLY L (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:JEFFERSON
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:PO BOX 1661
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1661
Mailing Address - Country:US
Mailing Address - Phone:662-453-2250
Mailing Address - Fax:662-453-2280
Practice Address - Street 1:1707 STRONG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-3923
Practice Address - Country:US
Practice Address - Phone:662-453-2250
Practice Address - Fax:662-453-2280
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor