Provider Demographics
NPI:1255456711
Name:KIMBLE, PETER B (ND)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3242
Mailing Address - Country:US
Mailing Address - Phone:217-787-3224
Mailing Address - Fax:
Practice Address - Street 1:2113 LINDSAY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3242
Practice Address - Country:US
Practice Address - Phone:217-787-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-00005175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath