Provider Demographics
NPI:1255368718
Name:KIRBY, KENNETH A (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:KIRBY
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 270
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-0270
Mailing Address - Country:US
Mailing Address - Phone:505-327-7476
Mailing Address - Fax:505-327-7389
Practice Address - Street 1:737 W ARRINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5528
Practice Address - Country:US
Practice Address - Phone:505-327-7476
Practice Address - Fax:505-327-7389
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1691111N00000X
KS0104408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor