Provider Demographics
NPI:1164446266
Name:ROLLHEISER-REVILLA, KIMBERLY M (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:ROLLHEISER-REVILLA
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 1:555 S RANCHO SANTA FE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-3698
Mailing Address - Country:US
Mailing Address - Phone:760-736-0286
Mailing Address - Fax:760-736-3113
Practice Address - Street 1:555 S RANCHO SANTA FE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3698
Practice Address - Country:US
Practice Address - Phone:760-736-0286
Practice Address - Fax:760-736-3113
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor