Provider Demographics
NPI:1780888503
Name:HUNTER, KIMBERLY SUE (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1386 CHEVIOT TRL
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-9067
Mailing Address - Country:US
Mailing Address - Phone:989-329-9733
Mailing Address - Fax:
Practice Address - Street 1:200 S DEYARMOND ST
Practice Address - Street 2:STE C
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-9108
Practice Address - Country:US
Practice Address - Phone:989-826-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP53580001OtherMEDICARE PTAN INDIVIDUAL
MI950F802520OtherBC/BS PIN
MI0P53580OtherMEDICARE PTAN GROUP