Provider Demographics
NPI:1134504285
Name:KIM, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 UNIVERSAL BLVD
Mailing Address - Street 2:APT 158
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8721
Mailing Address - Country:US
Mailing Address - Phone:407-873-9400
Mailing Address - Fax:
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-574-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor