Provider Demographics
NPI:1346353141
Name:FLEMING, KEVIN M (DC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:FLEMING
Suffix:
Gender:M
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-0646
Mailing Address - Country:US
Mailing Address - Phone:916-660-9923
Mailing Address - Fax:916-660-9953
Practice Address - Street 1:24388 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631
Practice Address - Country:US
Practice Address - Phone:530-367-2525
Practice Address - Fax:530-367-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 0270600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHF591AOtherPTAN
CAHF591AOtherPTAN