Provider Demographics
NPI:1538284625
Name:KIMBERLAIN, ROBERT S (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:KIMBERLAIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR STE 516
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4888
Mailing Address - Country:US
Mailing Address - Phone:502-259-9670
Mailing Address - Fax:502-259-9672
Practice Address - Street 1:4010 DUPONT CIR STE 516
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4888
Practice Address - Country:US
Practice Address - Phone:502-259-9670
Practice Address - Fax:502-259-9672
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00278001Medicare PIN