Provider Demographics
NPI:1942397294
Name:KIMMEL, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2419
Mailing Address - Country:US
Mailing Address - Phone:215-256-1385
Mailing Address - Fax:215-256-1386
Practice Address - Street 1:349 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2419
Practice Address - Country:US
Practice Address - Phone:215-256-1385
Practice Address - Fax:215-256-1386
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007187L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0274956000OtherKEYSTONE PERSONAL CHOICE
PA2560677OtherAETNA