Provider Demographics
NPI:1790213981
Name:FIELDER, KIMBERLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:
Last Name:FIELDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-9660
Mailing Address - Country:US
Mailing Address - Phone:704-241-2579
Mailing Address - Fax:
Practice Address - Street 1:337B E SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1544
Practice Address - Country:US
Practice Address - Phone:704-241-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor