Provider Demographics
NPI:1558704262
Name:KIMBRELL, MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KIMBRELL
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 1:10179 EASTERN SHORE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3302
Mailing Address - Country:US
Mailing Address - Phone:205-746-7183
Mailing Address - Fax:
Practice Address - Street 1:10179 EASTERN SHORE DR
Practice Address - Street 2:STE 102
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-3302
Practice Address - Country:US
Practice Address - Phone:205-746-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor