Provider Demographics
NPI:1770608986
Name:ZELL, KIM M (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:M
Last Name:ZELL
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 1:24865 5 MILE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3694
Mailing Address - Country:US
Mailing Address - Phone:313-531-2800
Mailing Address - Fax:
Practice Address - Street 1:24865 5 MILE RD
Practice Address - Street 2:STE 3
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3694
Practice Address - Country:US
Practice Address - Phone:313-531-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708852Medicaid
MIOH232920OtherBCBS OF MICHIGAN