Provider Demographics
NPI:1144416314
Name:GEBROSKY, KIM EDWARD (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:EDWARD
Last Name:GEBROSKY
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DOVE ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2412
Mailing Address - Country:US
Mailing Address - Phone:949-455-2772
Mailing Address - Fax:
Practice Address - Street 1:1301 DOVE ST
Practice Address - Street 2:SUITE 900
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2412
Practice Address - Country:US
Practice Address - Phone:949-455-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor