Provider Demographics
NPI:1609644897
Name:LLEWELLYN, KIMBER RAYNE (DC)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:RAYNE
Last Name:LLEWELLYN
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 1:353 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2177
Mailing Address - Country:US
Mailing Address - Phone:419-874-4840
Mailing Address - Fax:
Practice Address - Street 1:353 ELM ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2177
Practice Address - Country:US
Practice Address - Phone:419-874-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor