Provider Demographics
NPI:1902848641
Name:KIMEL, GENE BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:BRADLEY
Last Name:KIMEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17250 N 43RD AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4024
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WDBMW01Medicare ID - Type Unspecified