Provider Demographics
NPI:1124218086
Name:WILKENS, KYMBERLEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYMBERLEE
Middle Name:
Last Name:WILKENS
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 1:715 N HUMPHREYS ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3025
Mailing Address - Country:US
Mailing Address - Phone:928-853-8059
Mailing Address - Fax:206-202-2599
Practice Address - Street 1:715 N HUMPHREYS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3025
Practice Address - Country:US
Practice Address - Phone:928-853-8059
Practice Address - Fax:206-202-2599
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor