Provider Demographics
NPI:1396210720
Name:KIMBALL, MARINA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:SALIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 N 27TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3213
Mailing Address - Country:US
Mailing Address - Phone:605-644-9074
Mailing Address - Fax:
Practice Address - Street 1:311 N 27TH ST STE 2
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3213
Practice Address - Country:US
Practice Address - Phone:605-644-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor