Provider Demographics
NPI:1093837841
Name:STARK, KIMBERLY D (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:STARK
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 1:470 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1924
Mailing Address - Country:US
Mailing Address - Phone:973-831-6040
Mailing Address - Fax:973-831-6043
Practice Address - Street 1:470 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1924
Practice Address - Country:US
Practice Address - Phone:973-831-6040
Practice Address - Fax:973-831-6043
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ677539Medicare ID - Type Unspecified