Provider Demographics
NPI:1780768580
Name:BRANHAM, KIM YVONNE (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:YVONNE
Last Name:BRANHAM
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 1:301 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1659
Mailing Address - Country:US
Mailing Address - Phone:931-962-1999
Mailing Address - Fax:931-962-1999
Practice Address - Street 1:301 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1659
Practice Address - Country:US
Practice Address - Phone:931-962-1999
Practice Address - Fax:931-962-1999
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153870OtherBLUE CROSS BLUE SHIELD
TN3971367Medicare ID - Type Unspecified