Provider Demographics
NPI:1184835274
Name:KIMBERLY ANN PRIVITERA, PC
Entity Type:Organization
Organization Name:KIMBERLY ANN PRIVITERA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIVITERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-774-1776
Mailing Address - Street 1:8029 SE WOODSTOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5885
Mailing Address - Country:US
Mailing Address - Phone:503-774-1776
Mailing Address - Fax:
Practice Address - Street 1:8029 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5885
Practice Address - Country:US
Practice Address - Phone:503-774-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273094111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty