Provider Demographics
NPI:1740335249
Name:MARK KIMES DC CHIROPRACTIC INC
Entity type:Organization
Organization Name:MARK KIMES DC CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-757-2232
Mailing Address - Street 1:17 E SAN JOAQUIN STREET
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2903
Mailing Address - Country:US
Mailing Address - Phone:831-757-2232
Mailing Address - Fax:831-757-6415
Practice Address - Street 1:17 E SAN JOAQUIN STREET
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2903
Practice Address - Country:US
Practice Address - Phone:831-757-2232
Practice Address - Fax:831-757-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0175040Medicare ID - Type Unspecified
17504Medicare UPIN