Provider Demographics
NPI:1225465404
Name:KLEIN, KIMBERLY C (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:KLEIN
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 1:818NWMARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3295
Mailing Address - Country:US
Mailing Address - Phone:503-719-5335
Mailing Address - Fax:503-719-5334
Practice Address - Street 1:2709 NW CROSSING DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6793
Practice Address - Country:US
Practice Address - Phone:541-639-7229
Practice Address - Fax:541-728-0661
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor