Provider Demographics
NPI:1356344568
Name:NEIBERT, KIM LEE (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:LEE
Last Name:NEIBERT
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 1:3504 NORTH WHEELING AVENUE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2042
Mailing Address - Country:US
Mailing Address - Phone:765-284-1777
Mailing Address - Fax:765-284-1778
Practice Address - Street 1:3504 NORTH WHEELING AVENUE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2042
Practice Address - Country:US
Practice Address - Phone:765-284-1777
Practice Address - Fax:765-284-1778
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU09493Medicare UPIN
IN207920AMedicare PIN