Provider Demographics
NPI:1821696683
Name:KIMBALL, KELLY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:KIMBALL
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 1:1010 WISCONSIN AVE NW STE 345
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3680
Mailing Address - Country:US
Mailing Address - Phone:202-743-4104
Mailing Address - Fax:
Practice Address - Street 1:1010 WISCONSIN AVE NW STE 345
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3680
Practice Address - Country:US
Practice Address - Phone:202-743-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557640111N00000X
DCCH030221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor