Provider Demographics
NPI:1790954428
Name:KIMMEY ENTERPRISES
Entity Type:Organization
Organization Name:KIMMEY ENTERPRISES
Other - Org Name:RICHLAND CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:KIMMEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-444-1066
Mailing Address - Street 1:5316 ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9697
Mailing Address - Country:US
Mailing Address - Phone:724-444-1066
Mailing Address - Fax:724-444-1068
Practice Address - Street 1:5316 ROUTE 8
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9697
Practice Address - Country:US
Practice Address - Phone:724-444-1066
Practice Address - Fax:724-444-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004785-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicare UPIN