Provider Demographics
NPI:1487674479
Name:SHARP, KIMBERLEY RAE (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:RAE
Last Name:SHARP
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 1:2219 SOUTHLEA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3640
Mailing Address - Country:US
Mailing Address - Phone:937-648-9684
Mailing Address - Fax:
Practice Address - Street 1:2074 MANN ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1686
Practice Address - Country:US
Practice Address - Phone:231-759-8100
Practice Address - Fax:231-755-2142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor