Provider Demographics
NPI:1467503870
Name:CINCILLA, KIMBERLY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:CINCILLA
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 1:524 W MEEKER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5766
Mailing Address - Country:US
Mailing Address - Phone:253-850-9973
Mailing Address - Fax:253-850-1405
Practice Address - Street 1:524 W MEEKER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5766
Practice Address - Country:US
Practice Address - Phone:253-850-9973
Practice Address - Fax:253-850-1405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854681Medicare ID - Type Unspecified