Provider Demographics
NPI:1114246444
Name:AGUAYO, KIM KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:KATHLEEN
Last Name:AGUAYO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:KATHLEEN
Other - Last Name:AGUAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:CA
Mailing Address - Zip Code:95689-0296
Mailing Address - Country:US
Mailing Address - Phone:209-296-1766
Mailing Address - Fax:
Practice Address - Street 1:17071 RAMS HORN GRADE
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:CA
Practice Address - Zip Code:95689
Practice Address - Country:US
Practice Address - Phone:209-296-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor