Provider Demographics
NPI:1790922391
Name:DR KIM CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR KIM CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:SHEKINAH HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAP
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:805-777-8154
Mailing Address - Street 1:650 S WESTLAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3885
Mailing Address - Country:US
Mailing Address - Phone:805-777-8154
Mailing Address - Fax:805-777-8157
Practice Address - Street 1:650 S WESTLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3885
Practice Address - Country:US
Practice Address - Phone:805-777-8154
Practice Address - Fax:805-777-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22741111N00000X
CAAC12636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty