Provider Demographics
NPI:1598962318
Name:KIMBRIEL, JAMES W (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:KIMBRIEL
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 1:2281 PYRAMID WAY
Mailing Address - Street 2:STE 16
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2161
Mailing Address - Country:US
Mailing Address - Phone:775-355-6711
Mailing Address - Fax:775-355-7045
Practice Address - Street 1:2281 PYRAMID WAY
Practice Address - Street 2:STE 16
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2161
Practice Address - Country:US
Practice Address - Phone:775-355-6711
Practice Address - Fax:775-355-7045
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37777Medicare ID - Type UnspecifiedINDIVIDUAL LEGACY NUMBER