Provider Demographics
NPI:1518312107
Name:INGRAM-MORLACCI, KIMBERLY C (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:C
Last Name:INGRAM-MORLACCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:INGRAM-MORLACCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4573 STATE ROUTE 66 STE 2
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-2045
Mailing Address - Country:US
Mailing Address - Phone:412-508-9109
Mailing Address - Fax:
Practice Address - Street 1:4573 STATE ROUTE 66 STE 2
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-2045
Practice Address - Country:US
Practice Address - Phone:412-508-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-4589-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor