Provider Demographics
NPI:1457367450
Name:KIMBALL, STEPHEN WARD (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WARD
Last Name:KIMBALL
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 1:203 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1125
Mailing Address - Country:US
Mailing Address - Phone:989-345-0070
Mailing Address - Fax:989-345-6022
Practice Address - Street 1:203 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1125
Practice Address - Country:US
Practice Address - Phone:989-345-0070
Practice Address - Fax:989-345-6022
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301003003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X37729Medicare UPIN
M77500001Medicare ID - Type Unspecified
T33482Medicare ID - Type Unspecified