Provider Demographics
NPI:1689789117
Name:SIDEBOTTOM, STEVEN KIM (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KIM
Last Name:SIDEBOTTOM
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 1:293 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-7655
Mailing Address - Country:US
Mailing Address - Phone:304-485-1251
Mailing Address - Fax:304-485-0306
Practice Address - Street 1:293 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-7655
Practice Address - Country:US
Practice Address - Phone:304-485-1251
Practice Address - Fax:304-485-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV306111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131692000Medicaid
WV0131692000Medicaid
WVT32337Medicare UPIN