Provider Demographics
NPI:1770855207
Name:KIMBERLY S ANDERSON DC PLC
Entity Type:Organization
Organization Name:KIMBERLY S ANDERSON DC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:231-723-2221
Mailing Address - Street 1:50 FILER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2726
Mailing Address - Country:US
Mailing Address - Phone:231-723-2221
Mailing Address - Fax:231-723-5078
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-723-2221
Practice Address - Fax:231-723-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty