Provider Demographics
NPI:1609909324
Name:KIMBLE, SCOTT DAVID (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:KIMBLE
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:PO BOX 219
Mailing Address - Street 2:413 E CALVERT
Mailing Address - City:KARNES CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78118
Mailing Address - Country:US
Mailing Address - Phone:830-780-2213
Mailing Address - Fax:830-780-2558
Practice Address - Street 1:413 E CALVERT
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118
Practice Address - Country:US
Practice Address - Phone:830-780-2213
Practice Address - Fax:830-780-2558
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Z250Medicare ID - Type Unspecified
T14186Medicare UPIN