Provider Demographics
NPI:1073890752
Name:HARPENAU, KIMBERLY SARA (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SARA
Last Name:HARPENAU
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 1:29930 W 12 MILE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3983
Mailing Address - Country:US
Mailing Address - Phone:734-558-7498
Mailing Address - Fax:
Practice Address - Street 1:29930 W 12 MILE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3983
Practice Address - Country:US
Practice Address - Phone:734-558-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor