Provider Demographics
NPI:1790729010
Name:KIMEL CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:KIMEL CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:KIMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-993-1722
Mailing Address - Street 1:13615 N 35TH AVE
Mailing Address - Street 2:#1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-993-1722
Mailing Address - Fax:602-866-0219
Practice Address - Street 1:13615 N 35TH AVE
Practice Address - Street 2:#1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-993-1722
Practice Address - Fax:602-866-0219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMEL CHIROPRACTIC CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4269111N00000X
AZ5350111N00000X
AZ7481111N00000X
AZ7857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBMWMedicare UPIN