Provider Demographics
NPI:1619115490
Name:KIM, MONICA AMY (DC)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:AMY
Last Name:KIM
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 1:1451 CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7457
Mailing Address - Country:US
Mailing Address - Phone:850-294-5280
Mailing Address - Fax:
Practice Address - Street 1:40 ALEXANDRIA BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8910
Practice Address - Country:US
Practice Address - Phone:407-359-0047
Practice Address - Fax:407-359-0071
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor