Provider Demographics
NPI:1770597254
Name:KIMBALL, ZACHARY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ALLEN
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:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
M77500003Medicare ID - Type Unspecified
T33482Medicare UPIN