Provider Demographics
NPI:1740313808
Name:BARTHOLOMEW, KIMBERLY K (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:BARTHOLOMEW
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:KAMIAH
Mailing Address - State:ID
Mailing Address - Zip Code:83536-0147
Mailing Address - Country:US
Mailing Address - Phone:208-935-0342
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536-9700
Practice Address - Country:US
Practice Address - Phone:208-935-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-688111N00000X
MT701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000534800Medicaid
ID000534800Medicaid
IDU61381Medicare UPIN