Provider Demographics
NPI:1417196049
Name:KINGSLEY, AMBER NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:KINGSLEY
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 1:1012 CARVER RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4732
Mailing Address - Country:US
Mailing Address - Phone:209-549-2215
Mailing Address - Fax:209-549-2216
Practice Address - Street 1:1012 CARVER RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4732
Practice Address - Country:US
Practice Address - Phone:209-549-2215
Practice Address - Fax:209-549-2216
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31121OtherCHIROPRACTIC LICENSE
CA4031738OtherMEDICAL
CADC0311210OtherBLUE SHIELD PIN
CACM101AOtherPTAN