Provider Demographics
NPI:1629264700
Name:KIMEL, MICHELE GENENE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:GENENE
Last Name:KIMEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:GENENE
Other - Last Name:MERRIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17250 NORTH 43RD AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4024
Mailing Address - Country:US
Mailing Address - Phone:602-993-1722
Mailing Address - Fax:602-428-6975
Practice Address - Street 1:13615 N 35TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1243
Practice Address - Country:US
Practice Address - Phone:602-993-1722
Practice Address - Fax:602-866-0219
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor