Provider Demographics
NPI:1124380589
Name:WHITE, KIMBERLY S (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:SHIPLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2310 N MOLTER RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5036
Mailing Address - Country:US
Mailing Address - Phone:509-924-4443
Mailing Address - Fax:509-924-1249
Practice Address - Street 1:2310 N MOLTER RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5036
Practice Address - Country:US
Practice Address - Phone:509-924-4443
Practice Address - Fax:509-924-1249
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60287673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8910053OtherMEDICARE PTAN