Provider Demographics
NPI:1669964771
Name:LEUPOLD, KIMBERLY (LAC, DACM)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:LEUPOLD
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:LEUPOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3033 OGDEN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1976
Mailing Address - Country:US
Mailing Address - Phone:847-571-5455
Mailing Address - Fax:
Practice Address - Street 1:3033 OGDEN AVE STE 302
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1976
Practice Address - Country:US
Practice Address - Phone:847-571-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist