Provider Demographics
NPI:1639678147
Name:KIMBLEY, DANIEL CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHRISTOPHER
Last Name:KIMBLEY
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 1:34085 PACIFIC COAST HWY STE 114
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2765
Mailing Address - Country:US
Mailing Address - Phone:949-356-0556
Mailing Address - Fax:
Practice Address - Street 1:34085 PACIFIC COAST HWY STE 114
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2765
Practice Address - Country:US
Practice Address - Phone:949-356-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor