Provider Demographics
NPI:1760736029
Name:JIMMERSON, KEVIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:JIMMERSON
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 1:222 15TH ST S STE C
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2459
Mailing Address - Country:US
Mailing Address - Phone:406-727-5231
Mailing Address - Fax:406-727-6392
Practice Address - Street 1:222 15TH ST S STE C
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2459
Practice Address - Country:US
Practice Address - Phone:406-727-5231
Practice Address - Fax:406-727-6392
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-2339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor