Provider Demographics
NPI:1154817328
Name:SHIMER, KEVIN PAUL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PAUL
Last Name:SHIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E NORTH ST STE B
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9052
Mailing Address - Country:US
Mailing Address - Phone:630-365-5820
Mailing Address - Fax:630-365-5815
Practice Address - Street 1:701 E NORTH ST STE B
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-9052
Practice Address - Country:US
Practice Address - Phone:630-365-5820
Practice Address - Fax:630-365-5815
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor