Provider Demographics
NPI:1588823520
Name:SCARLASSARA, KIMBERLY KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:SCARLASSARA
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 1:202 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1433
Mailing Address - Country:US
Mailing Address - Phone:906-265-9000
Mailing Address - Fax:906-265-9009
Practice Address - Street 1:202 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1321
Practice Address - Country:US
Practice Address - Phone:906-265-9000
Practice Address - Fax:906-265-9009
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
9768211OtherAETNA
MI950C610140OtherBCBSMI
9768211OtherAETNA