Provider Demographics
NPI:1710985486
Name:QUEEN, KIMBERLY D (DC, CNS, DACBN)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:QUEEN
Suffix:
Gender:F
Credentials:DC, CNS, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 SW WASHINGTON SQUARE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4491
Mailing Address - Country:US
Mailing Address - Phone:503-291-7155
Mailing Address - Fax:503-291-7152
Practice Address - Street 1:9020 SW WASHINGTON SQUARE RD
Practice Address - Street 2:STE 500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4491
Practice Address - Country:US
Practice Address - Phone:503-291-7155
Practice Address - Fax:503-291-7152
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3106111N00000X
OR238111NN1001X
OR17105133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition