Provider Demographics
NPI:1982864260
Name:KIMBALL, TONY PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:PATRICK
Last Name:KIMBALL
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:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-0261
Mailing Address - Country:US
Mailing Address - Phone:970-884-3312
Mailing Address - Fax:
Practice Address - Street 1:357 NORTH MOUNTAIN VIEW DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:970-884-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor