Provider Demographics
NPI:1356880140
Name:KIM, SHEILA (DC)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOLLISTER RD
Mailing Address - Street 2:C/O GOLD'S GYM
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLISTER RD
Practice Address - Street 2:C/O GOLD'S GYM
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1148
Practice Address - Country:US
Practice Address - Phone:201-365-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00743000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor