Provider Demographics
NPI:1851473474
Name:ROUSSEAU, KIMBERLY (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ROUSSEAU
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 1:46840 HIGHWAY 1 STE 7
Mailing Address - Street 2:
Mailing Address - City:BIG SUR
Mailing Address - State:CA
Mailing Address - Zip Code:93920-9507
Mailing Address - Country:US
Mailing Address - Phone:831-667-2211
Mailing Address - Fax:
Practice Address - Street 1:46840 HIGHWAY 1 STE 7
Practice Address - Street 2:
Practice Address - City:BIG SUR
Practice Address - State:CA
Practice Address - Zip Code:93920-9507
Practice Address - Country:US
Practice Address - Phone:831-667-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor