Provider Demographics
NPI:1780802868
Name:SELIR, KIMBERLY (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SELIR
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 1:806 DEKALB AVE #2
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2050
Mailing Address - Country:US
Mailing Address - Phone:630-852-0766
Mailing Address - Fax:630-852-6159
Practice Address - Street 1:806 DEKALB AVE #2
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2050
Practice Address - Country:US
Practice Address - Phone:630-852-0766
Practice Address - Fax:630-852-6159
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL88260Medicare ID - Type Unspecified
IL27018Medicare UPIN